Surgical management of proximal femoral fracture with proximal femoral nail in adults

INTRODUCTION Proximal Femoral Fracture (PFF), commonly seen in elderly osteoporotic patients, poses difficulties in achieving and maintaining stable fixation. Surgical treatment is essential because of limited role of conservative management. Use of Proximal Femoral Nail (PFN) for these fracture management has advantage of early mobilization, minimum blood loss, minimal infection and malunion rate. MATERIAL AND

Methods

A prospective observational study was conducted among 50 patients in Orthopedics department at Universal College of Medical Sciences-Teaching Hospital (UCMS-TH) from April 2024 to October 2025. Selected patients with PFF were treated with PFN and they were followed post operatively at 6 weeks, 3 months and 6 months. At 6 months, Functional outcomes were assessed by using Kyle’s criteria.

Results

Among 50 patients, most fractures were AO/OTA 31-A3 (50%) and Boyd–Griffin type III (42%). In 86% of cases, short PFN was used. The average duration to surgery was 3.12 days and the mean Tip Apex Distance (TAD) difference was of 1.44 mm. The average duration of fracture union was 10.56 weeks. Complications were minimal with lateral migration of screw among 8% cases. At 6 months, 98% of patient had excellent to good functional outcomes. Neck shaft angle was well maintained during 6 month follow up and the agreement was statistically significant (p<0.05), however no significant association was observed between fracture type and functional outcome.

Conclusion

Proximal femoral nail is an effective surgical treatment method for PFF with excellent functional outcome and minimal complication. Early postoperative neck shaft alignment strongly predicts long-term angular stability, while fracture classification does not significantly influence functional recovery.