Comparison of proximal femoral nail and hemiarthroplasty outcomes in elderly (over 80 years old) patients with intertrochanteric fractures

Abstract

Aim: Proximal femoral nail (PFNA) and hemiarthroplasty are the two most frequently used methods in the surgical treatment of intertrochanteric femur fractures. The study aimed to determine the priority choice for surgical treatment in elderly patients (over 80 years old). Methods: Patients treated for intertrochanteric femur fractures between 2012 and 2017 were retrospectively analyzed. Patients aged 80 years and over who were treated with hemiarthroplasty or PFNA were included in the study. Length of the operation, need for postoperative intensive care, Harris Hip Score, postoperative complications, and mortality rates in the first year were compared. Results: A total of 120 patients with intertrochanteric femur fractures older than 80 years were evaluated. There were 43 patients (35.8) in the hemiarthroplasty group and 77 (64.2) in the PFNA group. No significant differences were found between the two groups in terms of mortality, need for postoperative intensive care, Harris Hip Score, and postoperative complications in the first year. While the median operation time was 45 minutes (IQR 40-50) in the PFNA group, it was 80 minutes (IQR 75-85) in the hemiarthroplasty group (p <0.001). The length of the operation was shorter in the PFNA group. Conclusion: In elderly patients, there were no significant differences between the surgical treatment modalities as hemiarthroplasty and PFNA in treating intertrochanteric fractures considering the postoperative outcomes and mortality rates within the first year. However, shorter operation time might be an advantage of PFNA.