Functional Outcomes of Hip Fracture Surgery in Elderly Patients at a Tertiary Care Hospital in a Rural Area of North India

Introduction: Hip fractures in the elderly are associated with significant morbidity, reduced functional independence, and an increased healthcare burden. Functional recovery following surgical management remains a key determinant of patient outcomes, particularly in populations in which daily activities require a higher degree of mobility. This study aimed to evaluate functional outcomes following hip fracture surgery in elderly patients and to compare recovery across fracture types and surgical interventions. Materials and methods: This prospective observational study included 161 patients aged ≥60 years with proximal femoral fractures that were managed surgically at Dr. Rajendra Prasad Government Medical College (Dr. RPGMC), Kangra, in Tanda, Himachal Pradesh, India. Baseline demographic and clinical data were recorded. Functional outcomes were assessed using the Functional Ambulation Category and Modified Harris Hip Score postoperatively on day one, fourteen days, six weeks, three months, six months, nine months, and one year later. Culturally relevant functional abilities such as squatting and sitting cross-legged were also evaluated. Statistical analysis was performed using repeated measures analysis of variance and chi-square test, with p<0.05 considered significant. Results: Intertrochanteric fractures were the most common type, followed by femoral neck fractures and subtrochanteric fractures. Closed reduction and internal fixation with proximal femoral nailing was the predominant intervention. Surgery was performed after six days in 113 patients (70.2%). Postoperative complications were observed in three patients (1.9%), and 143 patients (88.8%) survived. Functional Ambulation Category scores improved significantly from the immediate postoperative period to one year (p<0.001), with no significant differences between fracture types or surgical interventions (p>0.05). Similarly, the Modified Harris Hip Score showed significant improvement over time (p<0.001) without significant intergroup differences (p>0.05). However, better recovery of squatting and cross-legged sitting was observed in patients treated with arthroplasty at nine months and one year (p<0.05). Conclusion: Hip fracture surgery in elderly patients resulted in significant functional improvement over time. While the overall outcomes are comparable across surgical modalities, arthroplasty offers advantages in restoring culturally relevant functional activities.