Comparative Evaluation of Outcomes of Intertrochanteric Femur Fractures Treated with Proximal Femur Nail versus Proximal Femur Nail with Trochanteric Support Plate: A Prospective Comparative Study

Abstract

Background: Intertrochanteric femur fractures are common injuries, particularly in older adults, and are associated with substantial morbidity and functional impairment. Proximal femur nail (PFN) is widely used because of its intramedullary load-sharing characteristics. Unstable fractures with compromised lateral wall integrity may require additional lateral buttressing. Trochanteric support plate (TSP) augmentation has been proposed for this purpose. Methods: This prospective comparative study was conducted in the Department of Orthopaedics, National Institute of Medical Sciences & Research, Jaipur, over 18 months. Seventy patients with intertrochanteric femur fractures were included, with 35 patients treated with PFN alone and 35 with PFN plus TSP. Functional outcome was assessed using the Harris Hip Score (HHS), and radiological healing using the Radiographic Union Score for Hip (RUSH). Operative time, blood loss, hospital stay, weight-bearing, limb shortening and complications were also recorded. Results: Mean age was 60.4 ± 14.2 years in the PFN group and 66.8 ± 12.5 years in the PFN + TSP group. Stable fractures constituted 80% of the PFN group, whereas 85.7% of the PFN + TSP group had unstable fractures. Mean operative time was 82 ± 12 versus 112 ± 15 minutes, and mean blood loss was 170 ± 40 versus 290 ± 90 mL. Mean time to partial weight bearing was 8 ± 5 versus 42 ± 2 days. Mean HHS at 6 weeks, 12 weeks and 6 months was 78 ± 8, 92 ± 6 and 98 ± 4 with PFN, compared with 60 ± 10, 75 ± 9 and 88 ± 10 with PFN + TSP. RUSH scores at 6 months were 29 ± 1 and 27 ± 2, respectively. Early and late complications were reported only in the PFN + TSP group in the dissertation dataset. Conclusion: In this cohort, PFN alone was associated with shorter operative time, lower blood loss, earlier weight bearing, better HHS and higher RUSH scores. PFN + TSP was predominantly used for unstable 31A2 and 31A3 fractures and should be considered selectively when additional lateral wall support is required.