Management of intertrochanteric femur fractures in the elderly: Exploring the role of proximal femoral nail antirotation: A two year prospective study

Background: The high incidence of intertrochanteric femur fractures among the elderly population necessitates an efficient and effective surgical intervention. Amidst ongoing debate and research regarding the optimal implant selection, this study aims to elucidate the role of Proximal Femoral Nail Antirotation (PFNA) as a potentially ideal choice. Methods: This two-year prospective study was conducted at a multi-specialty hospital in Kasaragod, Kerala, encompassing 50 patients who met the requisite inclusion criteria. Functional and radiological outcomes were assessed at regular intervals up to two years post-surgery. Demographic parameters, fracture details, surgical specifics, and complications were meticulously documented. Results: The study cohort comprised a higher proportion of male patients (56%) with right-sided injuries (58%) predominating. The mean age of patients was 79±6.67 years. The majority of patients sustained fractures due to falls (82%), with type 31A2 (64%) being the predominant fracture classification. The surgical procedures had a mean duration of 39±11.6 minutes with a mean blood loss of 139±27.3 ml. MHHS revealed excellent results in 25(50%), good results in 22(44%), fair and poor results in two(4%) and one(2%) patient Conclusion: Proximal Femoral Nail Antirotation (PFNA) demonstrated high efficacy as an implant choice in this study by minimizing surgery time, blood loss, and complications. It facilitated favorable functional and radiological outcomes at the final follow-up in the majority of elderly patients. However, a larger multi-centric study is warranted to further investigate the efficacy and potential complications associated with this implant.