Functional Outcome of Proximal Femoral Nail in Unstable Peritrochanteric Fractures

Abstract

Background: Unstable peritrochanteric fractures are a major challenge in orthopedic trauma, with high morbidity and mortality, especially among the elderly. Their incidence is rising in Nepal due to an aging population. The Proximal Femoral Nail (PFN) provides stable fixation for these fractures, but data on functional outcomes in resource-limited settings are limited. This prospective study evaluated Harris Hip Score outcomes in patients treated with PFN at a tertiary care center in Nepal.
Methods: A prospective interventional study was conducted at Karnali Academy of Health Sciences from November 2021 to May 2025. Forty-seven patients with unstable AO/OTA 31-A2 and 31-A3 fractures were treated with PFN and followed for 18 months. The primary outcome was functional recovery measured using the Harris Hip Score (HHS) at scheduled intervals. Statistical analysis was performed using repeated measures ANOVA to assess changes over time and identify predictors of outcome.
Results: The mean age of patients was 69.45 ± 11.17 years, with a male predominance (53.2%). The mean HHS improved significantly from 30.57 ± 5.10 at 1 month to 73.30 ± 25.97 at 18 months (Wilks’ Lambda = 0.636, F = 7.98, p = 0.003). Age and operative time were significant predictors of functional outcome (Age: F=13.02, p=0.001; Operative time: F=11.42, p=0.002). The overall complication rate was 36.1%, with varus collapse observed in 19.1% of patients and screw cutout in 17.0%; however, the presence of these complications did not significantly impact the final functional recovery (p > 0.05).
Conclusions: PFN fixation effectively treats unstable peritrochanteric fractures in Nepali patients, showing sustained 18-month improvement, especially for younger patients with shorter operative times, proving successful even in resource-limited settings.
Keywords:  Functional outcome harris hip score; peritrochanteric fractures; proximal femoral nail; rural Nepal.