# Fracture stability modifies the risk profile and outcomes of proximal femoral nailing versus hemiarthroplasty for elderly intertrochanteric fractures

## TL;DR

This study compares two surgical treatments for hip fractures in elderly patients, finding that implant choice should depend on fracture stability and patient goals.

## Contribution

The study reveals a clinical trade-off between early mobilization and long-term outcomes based on fracture stability in elderly intertrochanteric fracture treatment.

## Key findings

- PFNA showed better 12-month hip function than HA in unstable fractures despite slower early recovery.
- HA enabled faster weight-bearing in unstable fractures but had worse long-term outcomes.
- For stable fractures, PFNA and HA had similar outcomes in hip function.

## Abstract

With population aging, intertrochanteric fractures (ITFs) in elderly individuals are increasingly common, and the choice between proximal femoral nail antirotation (PFNA) and hemiarthroplasty (HA) remains under debate, particularly regarding the optimal balance between early mobilization and the risk of long-term implant failure or revision. This study aimed to investigate this trade-off through a retrospective cohort comparison of PFNA and HA in elderly ITF patients stratified by fracture stability.

This retrospective cohort study reviewed 372 elderly patients with ITF treated from 2016 to 2022. Patients were grouped by surgery (PFNA or HA) and stratified by fracture stability (AO/OTA classification). The primary outcome was the Harris hip score (HHS) at 12 months post-operatively; secondary outcomes included perioperative metrics and complications.

Overall, PFNA group demonstrated higher 12-month HHS (87.9 ± 5.8 vs. 84.6 ± 6.3, p < 0.001) despite longer operative duration, hospital stays, and delayed weight-bearing (p < 0.05) than HA. Subgroup analysis revealed no difference in HHS at 12 months for stable ITF patients. In the unstable subgroup, HA enabled earlier weight-bearing (4.5 ± 3.3 vs. 8.5 ± 3.7 days, p < 0.001), but PFNA demonstrated significantly better 12-month HHS (88.3 ± 6.3 vs. 82.5 ± 6.3, p < 0.001), with less blood loss and lower costs.

For stable ITFs in elderly patients, the PFNA and HA yield comparable outcomes. For unstable ITFs, a clinical trade-off exists: HA provides faster early mobilization, whereas PFNA offers superior long-term hip function. Implant choice should be tailored to patient life expectancy and functional goals.