Proximal Femoral Nailing Versus Hemiarthroplasty for Unstable Trochanteric Fractures of Femur in Elderly Patients – A Randomized Controlled Study

Background: Unstable intertrochanteric fractures in elderly patients are associated with substantial morbidity, loss of independence, and complications related to prolonged immobilization. Proximal femoral nailing preserves the native hip and reduces operative trauma, whereas hemiarthroplasty permits early weight-bearing. The objective is to compare the functional and radiological outcomes and complications of proximal femoral nailing and cemented bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures. Material and Methods: This randomized controlled study included 60 patients aged 65 years or older with AO/OTA type 31-A2 or 31-A3 unstable intertrochanteric fractures. Patients were randomized into a proximal femoral nail group and a cemented bipolar hemiarthroplasty group, with 30 patients in each. Operative time, blood loss, transfusion requirements, postoperative complications, radiological outcomes, Harris Hip Score, Oxford Hip Score, Visual Analogue Scale, and Activities of Daily Living scores were assessed at three months, six months, and final follow-up. Results: Proximal femoral nailing was associated with shorter operative time, lower blood loss, and reduced transfusion requirements (p<0.01). Hemiarthroplasty had fewer respiratory complications and bed sores and demonstrated significantly better Harris Hip and Oxford Hip scores with lower pain at three months. At six months and final follow-up, functional outcomes were comparable between the groups. All fractures in the PFN group united at a mean of 15 weeks. Implant irritation was more frequent after PFN, whereas all hemiarthroplasty patients achieved optimal stem fixation. Conclusion: Proximal femoral nailing offers intraoperative advantages, while hemiarthroplasty provides better early function and fewer immobilization-related complications. Both procedures achieve comparable functional outcomes at final follow-up.

Keywords: Intertrochanteric fracture, proximal femoral nail, hemiarthroplasty, elderly, Harris Hip Score, osteoporosis.