Trochanteric Buttress Plate Augmentation of the Proximal Femoral Nail for Unstable Intertrochanteric Fractures: A Randomized Controlled Trial

Background: Unstable intertrochanteric (IT) fractures pose a significant challenge in orthopedic surgery. Objective: To investigate the effectiveness of combining a trochanteric buttress plate (TBP) with a proximal femoral nail (PFN) for managing unstable IT fractures. Methods: This randomized controlled open-label study was performed on 90 patients with recent unstable IT fractures (Evans types 1c, 1d, 1e, or 2). Patients were randomly divided into two groups: Group A was treated with standard PFN fixation. Group B was treated with PFN integrated with TBP augmentation. Assessments were conducted at two weeks and monthly for six months. Functional outcomes were assessed using the modified Harris Hip Score (mHHS). Results: Operative time and blood loss were significantly higher in Group B (PFN+TBP) than in Group A (standard PFN) (P = 0.005 and 0.006, respectively). Postoperative mHHS was significantly higher in Group B at all follow-up intervals from two weeks to six months (P < 0.05). Conclusions: The integration of the TBP with PFN for unstable IT fractures significantly improves functional outcomes without increasing major complications, despite a modest increase in operative time and blood loss.