Surgical outcomes for proximal femoral fractures: a longitudinal analysis pre- and post-pandemic

Proximal femoral fractures are a major cause of disability in older adults and require timely surgical treatment. This study aimed to compare perioperative and clinical outcomes of elderly patients with proximal femoral fractures treated during the pre-COVID-19 (2018–2019), COVID-19 (2020–2021), and post-COVID-19 (2022–2023) periods. This retrospective observational study included 530 patients aged ≥ 65 years who underwent surgery within 48 h of admission at a tertiary referral center. Surgical procedures included intramedullary nailing (IMN), hemiarthroplasty (HA), and total hip arthroplasty (THA). Demographic characteristics, fracture type, operative time, postoperative complications, reoperations, Visual Analog Scale (VAS), Harris Hip Score (HHS), Nottingham Hip Fracture Score (NHFS), and length of hospital stay were evaluated. Longitudinal outcomes were analyzed using linear mixed-effects and multivariable regression models. A total of 530 patients were included. Baseline demographic characteristics and NHFS were comparable among the three study periods. Operative time progressively decreased over time, with the greatest reduction observed for IMN procedures (110.75, 95.05, and 61.94 min in the pre-COVID, COVID, and post-COVID periods, respectively; p < 0.001). Complication and reoperation rates remained low and showed no significant differences across study periods or fracture types. Pain progressively decreased and hip function significantly improved during follow-up in all cohorts, with no clinically relevant differences among the three periods. Increasing age and higher NHFS independently predicted poorer 12-month functional outcomes, whereas fracture pattern had only a limited influence on long-term recovery. Surgical management of proximal femoral fractures remained effective throughout the pre-COVID, COVID, and post-COVID periods. Progressive improvements in operative efficiency, particularly for IMN, were not associated with worse complications or clinical outcomes. These findings support the value of standardized multidisciplinary pathways and timely surgical management in maintaining favorable outcomes for elderly patients with proximal femoral fractures.