Comparative Outcomes of Proximal Femoral Nail Antirotation Versus Conservative Treatment in Super-Elderly Patients With Intertrochanteric Fractures.

Abstract

To evaluate the clinical efficacy of PFNA in treating intertrochanteric fractures in super-elderly patients. This study included patients aged over 90 years admitted to the orthopedic department of our hospital with intertrochanteric fractures between January 2021 and December 2023. The patients were categorized into two groups: the surgical group, which received treatment with PFNA, and the conservative group, which underwent tibial tubercle skeletal traction. PSM was additionally applied to control for confounding biases. Comparisons were conducted between the two groups concerning VAS scores at 1 week and 3 months post-admission, fracture healing time, complication rates, HHS, and SF-36 at the final follow-up, as well as 1-year survival rates. A total of 112 patients were enrolled, including 36 in the surgical group and 76 in the conservative group. After performing 1:1 PSM on baseline characteristics such as gender, age, BMI, bone density, Evans-Jensen classification, ASA grade, and CCI, 32 pairs of data were obtained, with 32 patients in the surgical group and 32 in the conservative group. Follow-up results indicated that the surgical group experienced faster pain relief, shorter fracture healing times, and lower incidence rates of most complications. Additionally, the HHS and SF-36 scores at the final follow-up were higher in the surgical group, and the one-year survival rate was also greater than that of the conservative group (<i>P</i> < 0.05). For super-elderly patients with relatively good physical conditions who suffer from intertrochanteric fractures, the use of PFNA fixation, compared to conservative treatment, can achieve better limb function, a lower incidence of complications, and a higher survival rate.