Outcome of intertrochanteric fractures in elderly patients having comorbidities treated with proximal femoral nail: A single center observational study

Abstract

Background and Objectives: Intertrochanteric fractures is one of the most frequently operated injuries in the elderly. The incidence of these fractures increases with increasing age. Many studies show certain parameters have an adverse effect on functional outcome and quality of life in patients with intertrochanteric fractures treated surgically. However, very few studies have evaluated the outcome of patients treated surgically having comorbidities such as hypertension, diabetes mellitus, anaemia and asthma.Methods: We conducted a prospective observational study of 30 patients aged 65 years or above, with at least one comorbidity (hypertension, diabetes mellitus, anaemia, asthma and cardiac dysfunction) who underwent PFN for closed intertrochanteric fractures at our hospital. Radiographs were reviewed at 1, 3, and 6 months or till fracture union, whichever came first. Result: In our study, 33% of patients (10) belonged to ASA grade 2, 47% of patients (14) belonged to grade 3, and 20% of patients (6) belonged to grade 4. In our study, 14 patients (46.6%) had one comorbidity, while 16 patients (53.4%) had two or more comorbidities. Harris Hip Score at the end of 3 months was 73.8 and at the end of 6 months was 84.3. Five patients had excellent, 17 patients had good, 7 patients had fair, and 1 patient had a poor functional outcome. Using Cox Regression analysis for hazard ratio of poor post-surgical Hip scores, we found a significant correlation between functional outcome and age of surgery, number of comorbidities, anaemia and length of hospital stay.Conclusion: Proximal femoral nail is a good choice for internal fixation of intertrochanteric fractures. The comorbidities and their correction should be taken into consideration before and after the operative procedure.