Functional Outcomes of Unstable Intertrochanteric Fractures Managed by Short Proximal Femoral Nail Antirotation Asia II: A Prospective Observational Study

BACKGROUND: Unstable intertrochanteric fractures in elderly patients require stable fixation and early mobilization to reduce morbidity and mortality. The Proximal Femoral Nail Antirotation Asia II (PFNA II) is designed to provide biomechanically stable fixation with minimal surgical trauma. OBJECTIVE: To evaluate the functional outcomes of unstable intertrochanteric fractures (AO types 31-A2.2 and 31-A2.3) managed with short PFNA II and to assess associated complications. METHODS: This prospective observational study included 30 patients (mean age: 73.5 years, range 54-88 years) with unstable intertrochanteric fractures treated with short PFNA II between May 2016 and January 2018. Functional outcomes were assessed using the Harris hip score (HHS) at 6 weeks, 3 months, and 6 months postoperatively. RESULTS: At 6-month follow-up, excellent outcomes (HHS 90-100) were achieved in 14 patients (47%) and good outcomes (HHS 80-89) in 14 patients (47%), giving a combined excellent-to-good rate of 94%. Mean HHS improved from 66.5 at 6 weeks to 87.8 at 6 months. Closed reduction was successful in 28 cases (93.3%). All fractures achieved union with a mean union time of 12.27 weeks. Complications occurred in 4 patients (13.3%): superficial infection (n = 2), helical blade cut-through (n = 1), and persistent limp (n = 1). No implant failures, nonunions, or deep infections were recorded. CONCLUSION: Short PFNA II provides reliable fixation for unstable intertrochanteric fractures with high rates of excellent-to-good functional outcomes and low complication rates, allowing early mobilization in elderly patients.