Functional Outcome Of Unstable Trochanteric Fractures Fixed Using Proximal Femoral Nail (Pfn)

Background: Unstable trochanteric fractures are a frequent cause of morbidity, particularly in the elderly, due to poor bone quality and high biomechanical stresses. Proximal femoral nails (PFN) have gained popularity over sliding hip screws owing to biomechanical advantages, but outcomes in unstable patterns remain an area of active investigation. This study aimed to evaluate functional outcomes, complications, and prognostic factors in unstable trochanteric fractures managed with PFN. Methods: A prospective observational study was conducted on 45 patients with unstable trochanteric fractures (Boyd and Griffin Type III/IV; AO/OTA 31-A2.2, A2.3, A3.2) treated with PFN between February 2023 and February 2025. Demographic data, comorbidities, and fracture classifications were documented. Surgeries followed a standardized technique, and patients were followed up at admission, 1 month, and 3 months. Functional outcomes were assessed using the Modified Harris Hip Score (MHHS). Complications and associations between injury mechanism and outcome were analysed. Results: The mean age was 61.4 years, with a male predominance (68.9%). Right-sided fractures were more common (60%), and falls were the most frequent cause of injury (37.8%). By Boyd and Griffin classification, Type III fractures predominated (57.8%), while AO/OTA classification showed 31-A2.2 as most common (40%). At admission, all patients had poor MHHS. By three months, 48.8% achieved good, 22.2% excellent, and 28.9% fair outcomes. The complication rate was 11.1% (malunion 6.7%, non-union 4.4%), with no implant failures. A statistically significant association (p = 0.04) was observed between mode of injury and functional outcome, with “other” mechanisms showing the highest proportion of excellent results. Conclusion: PFN provides stable fixation and favourable early outcomes in unstable trochanteric fractures, with 71% of patients achieving good to excellent function by three months. Complication rates were low, and outcomes were significantly influenced by mechanism of injury. PFN should be considered the preferred implant in these challenging fracture patterns, though longer-term studies are required to confirm durability of outcomes.