A Study on Functional Outcome of Proximal Femur Nailing Without Distal Locking In Intertrochanteric Fracture Cases

Abstract

Background: Intertrochanteric fractures are common injuries in the elderly and are associated with significant morbidity and loss of mobility. Proximal femur nailing (PFN) is widely accepted for their management; however, the necessity of distal locking in selected fracture patterns remains controversial. This study evaluated the functional outcomes of PFN without distal locking in intertrochanteric fractures.

Materials and Methods: This prospective hospital-based observational study was conducted in the Department of Orthopaedics, ESIC Medical College and Hospital, Kalaburagi, Karnataka, from June 2025 to May 2026. A total of 30 adult patients with AO/OTA 31-A1 and 31-A2 intertrochanteric fractures underwent PFN without distal locking. Patients were followed for 12 months. Clinical, radiological, and functional outcomes were assessed. Functional outcome was evaluated using the Harris Hip Score (HHS), while secondary outcomes included operative duration, blood loss, time to fracture union, time to full weight-bearing, hospital stay, and postoperative complications.

Results: The mean age of the patients was 66.2 ± 9.1 years, and 60% were males. Slip and fall was the most common mechanism of injury (63.3%). The mean operative duration was 56.7 ± 8.5 minutes, mean blood loss was 92.4 ± 18.9 mL, and mean hospital stay was 5.6 ± 1.3 days. Radiological union was achieved in 29 patients (96.7%) with a mean union time of 13.1 ± 2.0 weeks. The mean Harris Hip Score at final follow-up was 89.3 ± 8.2. Excellent functional outcomes were observed in 50.0% of patients, good outcomes in 33.3%, fair outcomes in 13.3%, and poor outcomes in 3.4%. Overall, 83.3% of patients achieved excellent or good functional results. Postoperative complications were minimal, with one case each of superficial infection, delayed union, and varus collapse, and no cases of implant failure, screw cut-out, nonunion, or reoperation.

Conclusion: Proximal femur nailing without distal locking is a safe and effective treatment for selected intertrochanteric fractures, providing high union rates, satisfactory functional outcomes, shorter operative time, and a low complication rate. Careful patient selection and meticulous surgical technique are essential for achieving optimal results.