Clinical-Radiological Outcomes of Early Versus Delayed Weight-Bearing Following Proximal Femoral Nail Antirotation 2 Fixation for Intertrochanteric Fractures: A Prospective Randomized Comparative Study

Background Intertrochanteric fractures commonly occur in elderly patients following minor trauma due to osteoporosis, arthritic hip changes, and balance disorders. Early mobilization is crucial to prevent complications of prolonged bed rest. This study compared Modified Harris Hip Scores (mHHS) between early and delayed weight-bearing protocols following proximal femoral nail antirotation 2 (PFNA2) fixation. Methodology This prospective randomized comparative study was conducted at a tertiary care center, where patients with intertrochanteric fractures treated with PFNA2 were randomly allocated before surgery into the following two groups: Group 1 (early weight-bearing within 24 hours post-surgery) and Group 2 (delayed weight-bearing after four weeks). Outcomes were assessed using mHHS and radiographs over 24 weeks. Results Of the 55 enrolled patients, 46 completed follow-up (21 in the early weight-bearing group, 25 in the delayed weight-bearing group; nine were lost to follow-up). At 24 weeks, mean mHHS was 82.28 ± 12.29 in the delayed group versus 84.95 ± 15.82 in the early group (p = 0.523). The tip-apex distance was 18.13 ± 4.04 mm versus 22.11 ± 9.68 mm (p = 0.068), and Parker's ratio was 0.56 ± 0.10 in both groups (p = 0.90). Conclusions Functional improvement and failure risk are independent of postoperative weight-bearing protocols. Early weight-bearing appears safe and effective, potentially facilitating faster patient mobilization without compromising outcomes. No statistically significant differences were found in mHHS between groups, indicating similar functional recovery. Radiological parameters (tip-apex distance and Parker's ratio) also showed no significant differences at union.