A Clinico-Radiological Comparative Study of Functional Outcome of Short Vs Long Proximal Femur Nail in Pertrochantric Femur Fractures

Background: One of the most prevalent osteoporotic fractures occurring in elderly individuals is the pertrochanteric femur fracture, which contributes to considerable morbidity, mortality and functional disability. As the PFN fixation has biomechanical benefits and allows the early mobilization, it has become the preferable treatment modality. Both short and long PFN are widely used; however, there is some controversy about the relative effectiveness in terms of operative efficiency, fracture healing and functional recovery. This study aimed to compare the functional and radiological result of Short Proximal Femoral Nail and Long Proximal Femoral Nail for treatment of pertrochanteric femur fractures. Material and Methods: This prospective randomized comparative study was conducted in the Department of Orthopaedics of a tertiary care teaching hospital over a period of 18 months. A total of 44 patients with fresh closed pertrochanteric femur fractures meeting the inclusion criteria were enrolled and randomly allocated into two groups: Group A (Short PFN, n=22) and Group B (Long PFN, n=22). Demographic variables, fracture characteristics, operative parameters, radiological outcomes, and functional outcomes were assessed. Functional evaluation was performed using the Harris Hip Score (HHS), while radiological assessment included fracture union, implant position, and complications. Statistical analysis was performed using Student’s t-test, Chi-square test, and Fisher’s exact test. A p-value <0.05 was considered statistically significant. Results: The mean age of the study population was 68.77 ± 8.03 years, and females constituted 61.4% of patients. Fall from standing height was the most common mode of injury (81.8%). AO 31-A2 fractures accounted for 52.3% of cases.The Short PFN group demonstrated significantly shorter operative duration (69.55 ± 5.02 vs 103.55 ± 5.72 minutes, p<0.001), lower blood loss (147.23 ± 7.70 vs 182.00 ± 9.80 ml, p<0.001), and reduced fluoroscopy time (43.55 ± 4.49 vs 61.59 ± 5.30 seconds, p<0.001) compared with the Long PFN group.Radiological union was achieved in all patients (100%). Mean time to union was 15.50 ± 0.51 weeks in the Short PFN group and 14.41 ± 0.50 weeks in the Long PFN group (p<0.001). No cases of varus collapse, screw cut-out, implant failure, or nonunion were observed. Functional outcomes were excellent in both groups. The mean Harris Hip Score was 90.77 ± 0.81 in the Short PFN group and 91.41 ± 2.34 in the Long PFN group (p=0.236). Excellent HHS outcomes were observed in 100% of Short PFN patients and 90.9% of Long PFN patients (p=0.488). Mild thigh pain occurred in only two patients in the Long PFN group. Conclusion: Both Short PFN and Long PFN provide excellent functional and radiological outcomes in the management of pertrochanteric femur fractures. Short PFN offers significant perioperative advantages, including reduced operative time, lower blood loss, and decreased fluoroscopy exposure. Although Long PFN demonstrated slightly earlier fracture union, functional outcomes and overall complication rates were comparable between the two groups. Implant selection should therefore be individualized based on fracture pattern, bone quality, patient factors, and surgeon preference.

Keywords: Pertrochanteric femur fracture; Proximal Femoral Nail; Short PFN; Long PFN; Harris Hip Score; Radiological union; Intertrochanteric fracture.