Functional results of intertrochanteric femur fractures after successful osteosynthesis with proximal femoral nails

Purpose: The aim of this study is to investigate the post-operative functional condition of patients who had intertrochanteric fractures and had successful fracture healing with proximal femoral nail. Materials and Methods: Patients over 65 years who were admitted to a single center with intertrochanteric femur fractures after fall injury between 2015-2017 and treated using proximal femoral nails (PFNA) were included to the study. Patients with less than one-year follow-up, who didn’t achieve radiological healing, who had pathological fractures or who had revision surgeries were excluded. To investigate daily activity levels and functional status related to hip joint, Turkish versions of “Oxford Hip Score (OHS)” and “Hip Disability and Osteoarthritis Outcome Score – Physical Function Shortform (HOOS-PS)” were used to question patients or their first-degree relatives. To inspect pain at rest or with activity, visual analogue scale (VAS) was used. To investigate mobility levels, “Palmer – Parker Mobility Score (PPM)” was used. Results: Among investigated 39 patients in whom osteosynthesis was performed for intertrochanteric femur fractures, 2 patients with pathological fractures, 2 with revision operation and 7 without required data were excluded. The average age of 28 patients (20 female, 8 male) were 82,3±7,8. Same fixation implant (PFNA, Synthes) were used for the patients who were operated within 1,9±1,4 days. Median duration of post-operative hospital stay was found to be 6 days (2-71). Functional levels were investigated 18,1±9 months after the operation. 8 patients were deceased during follow-up, with surgery associated etiologies in 4. 21 patients who were questioned had mean VAS score at rest 2,3±1,4, mean VAS score with activity 3,5±1,8; OHS 30,4±12,2; HOOS-PS 10,9±5,1 and PPM 5,5±3,3. Among 21 patients who were alive, 8 of them were using additional support for ambulation (3 patient-walker, 5 patient-cane). Conclusion: Although PFNA is a successful treatment method in intertrochanteric femur fractures, patients do not reach the anticipated mobilization and functional levels when compared with healthy individuals at same age, even though they have low pain levels