Intertrochanteric fractures, a type of extracapsular proximal femoral fracture, are among the most common injuries encountered in the elderly population. These fractures account for nearly 50% of all hip fractures in individuals above the age of 65 years and are associated with significant morbidity, mortality, and healthcare burden globally [1]. In India, with a rapidly aging population, the incidence of hip fractures is expected to rise substantially, leading to increased socioeconomic and healthcare challenges [2].

These fractures typically occur due to low-energy trauma, such as a fall from standing height, and are frequently associated with osteoporosis, sarcopenia, and other age-related comorbidities [3]. The primary goals of treatment are to achieve stable fixation, promote early mobilization, and restore pre-injury functional status to reduce complications such as deep vein thrombosis, pulmonary embolism, pressure ulcers, and respiratory infections [4,5].

Surgical management is widely considered the gold standard for intertrochanteric fractures in elderly patients. Conservative treatment is rarely indicated due to its association with poor outcomes, including prolonged immobility and higher mortality rates [6]. Common surgical fixation methods include the Dynamic Hip Screw (DHS), widely used for stable fracture patterns, and the Proximal Femoral Nail (PFN), which is increasingly preferred for unstable or comminuted fractures due to its biomechanical advantages and intramedullary positioning [7,8].

While the success of surgical intervention is well established, the functional outcomes in elderly patients vary significantly depending on multiple factors such as fracture type, surgical technique, implant used, timing of surgery, and postoperative rehabilitation [9]. Comorbid conditions like diabetes, hypertension, cardiovascular diseases, and cognitive impairment further complicate the recovery process [10].

Despite the widespread adoption of modern fixation techniques, data on real-world functional outcomes in elderly Indian patients, particularly in tertiary care settings in states like Gujarat, remain limited. This study was undertaken to evaluate the functional outcomes following surgical fixation of intertrochanteric fractures in elderly patients in selected tertiary care hospitals across Gujarat. It aims to provide insights into patient recovery trajectories, identify prognostic factors, and suggest possible improvements in clinical management protocols.

This was a prospective observational study conducted over a period of one year across selected tertiary care hospitals in Gujarat. The study aimed to evaluate the functional outcome following surgical fixation of intertrochanteric fractures in elderly patients. Ethical clearance was obtained from the institutional ethics committees of the participating centers prior to the commencement of the study, and written informed consent was taken from all participants or their legal guardians.

Patients aged 60 years and above who were diagnosed with intertrochanteric fractures due to low-energy trauma and underwent surgical fixation were included in the study. The diagnosis was confirmed through clinical evaluation and radiographic imaging. Patients with pathological fractures, polytrauma, pre-existing neuromuscular disorders affecting ambulation, or those who were unfit for surgery were excluded.

All enrolled patients were treated surgically using either the Dynamic Hip Screw (DHS) or Proximal Femoral Nail (PFN), as determined by the attending orthopedic surgeon based on the fracture pattern and individual patient characteristics. Standard preoperative evaluation, including hematological and radiological investigations, was performed. Postoperative care included thromboprophylaxis, pain management, and a physiotherapy regimen tailored to each patient's condition. Early mobilization was encouraged whenever possible.

Data collected included patient demographics (age, sex), comorbidities, type of fracture, surgical technique used, intraoperative complications, and duration of hospital stay. Functional outcomes were assessed using the Modified Harris Hip Score at three intervals—6 weeks, 3 months, and 6 months postoperatively. This score evaluates pain, function, absence of deformity, and range of motion, with higher scores indicating better outcomes.

The data were analyzed using SPSS software. Descriptive statistics such as mean, standard deviation, and proportions were used to summarize baseline characteristics and outcomes. Repeated measures ANOVA was applied to compare changes in Harris Hip Scores over time, and a p-value of less than 0.05 was considered statistically significant.

The study included 85 elderly patients with intertrochanteric fractures treated surgically at tertiary care hospitals across Gujarat over a 1-year period. The following tables summarize the baseline characteristics, type of fixation, postoperative complications, functional outcomes over time, and the impact of comorbidities on recovery.

Table 1: Baseline Demographic and Clinical Characteristics of Patients (n = 85)

Table 1: This table presents demographic characteristics of the study population. Stable vs. unstable fractures were classified radiographically. Time to surgery refers to the duration from injury to definitive fixation.

Table 2: Distribution of Surgical Fixation Method According to Fracture Type

Table 2: This table shows the choice of implant based on fracture pattern. DHS (Dynamic Hip Screw) was preferred in stable fractures, while PFN (Proximal Femoral Nail) was more commonly used for unstable patterns.

Table 3: Postoperative Complications (n = 85)

Table 3: This table lists early postoperative complications observed in the study. Most complications were managed conservatively. Implant failure was associated with poor compliance and unstable fracture configuration.

Table 4: Functional Outcomes (Modified Harris Hip Score) at Follow-up Intervals

Table 4: This table summarizes the Modified Harris Hip Scores at different time points. A clear trend of functional improvement is observed over time, with the majority of patients achieving good to excellent function by 6 months.

Table 5: Influence of Comorbidities on 6-Month Functional Outcome

Table 5: This table shows the impact of various comorbidities on final functional outcomes at 6 months. Patients without comorbidities had significantly higher mean Harris Hip Scores and better overall recovery (p < 0.05).

Figure 1: This combined graph visually summarizes key findings from the study on intertrochanteric fracture fixation outcomes in elderly patients. The top-left panel illustrates the distribution of surgical fixation methods based on fracture type, showing that Dynamic Hip Screw (DHS) was predominantly used in stable fractures, while Proximal Femoral Nail (PFN) was the preferred choice for unstable fractures. The top-right panel displays the frequency of early postoperative complications, with superficial infections being the most common, followed by urinary tract infections and delayed union. The bottom-left panel depicts the trend in functional recovery using the Modified Harris Hip Score across three follow-up intervals, demonstrating progressive improvement with a notable increase in patients achieving good to excellent outcomes by 6 months. Finally, the bottom-right panel highlights the influence of comorbidities on 6-month functional outcomes, revealing that patients without comorbidities experienced significantly higher recovery rates, while those with multiple comorbid conditions had the poorest outcomes. Together, these graphical elements provide a comprehensive overview of patient demographics, surgical decisions, complication rates, functional recovery trajectory, and the impact of underlying health status on postoperative rehabilitation.

Intertrochanteric fractures in the elderly remain a significant public health concern due to their high incidence, complex treatment requirements, and associated morbidity and mortality. This study assessed the functional outcome of surgical fixation in elderly patients treated in tertiary care hospitals in Gujarat. Our findings demonstrate a consistent improvement in functional status over time, with 68.2% of patients achieving good to excellent outcomes by the 6-month follow-up, as assessed by the Modified Harris Hip Score.

The mean age of patients in our study was 72.4 years, consistent with global epidemiological data indicating that hip fractures are most prevalent in the seventh and eighth decades of life [1]. The nearly equal distribution of stable and unstable fractures (49.4% vs. 50.6%) aligns with prior studies, which suggest that unstable fracture patterns are common in osteoporotic bones due to low-energy trauma [2].

In terms of surgical modality, Dynamic Hip Screw (DHS) was more frequently used for stable fracture patterns, while Proximal Femoral Nail (PFN) was the preferred choice for unstable fractures—a trend consistent with the literature [3,4]. The biomechanical advantages of PFN, such as intramedullary positioning and load-sharing properties, make it particularly suitable for unstable fractures [5].

Our study demonstrated a progressive improvement in functional outcomes from 6 weeks to 6 months, with the most significant gains seen between 3 and 6 months. These findings are comparable to those reported by Boopalan et al., who found similar trends of functional improvement over time using the Harris Hip Score following fixation with either DHS or PFN [6].

Complication rates in our study were low and manageable, with superficial infection being the most common (7.1%). These rates are within the range reported in previous Indian studies, which cite wound infection rates ranging from 5% to 10% [7]. Implant failure was observed in 2.4% of patients, particularly among those with unstable fractures treated with DHS, underscoring the importance of appropriate implant selection. Several biomechanical studies have shown that DHS may not provide sufficient stability in unstable intertrochanteric fractures, leading to complications such as cut-out and varus collapse [8].

Patients with multiple comorbidities, particularly diabetes, cardiovascular disease, and hypertension, had poorer functional outcomes at 6 months compared to those without comorbidities. This supports the findings of Haentjens et al., who emphasized the role of comorbidities in prolonging recovery and increasing the risk of complications and mortality after hip fractures [9]. Our results also echo those of Simunovic et al., who reported that early surgery (within 48–72 hours) combined with structured rehabilitation was associated with significantly better functional outcomes and lower complication rates [10].

Interestingly, our findings reaffirm the importance of early mobilization and tailored physiotherapy. Patients who began rehabilitation within 48 hours postoperatively had significantly better Harris Hip Scores at all follow-up points. A study by Parker and Handoll also emphasized early mobilization as a key determinant of functional recovery, especially in elderly patients with limited physiological reserves [11].

In comparison with international literature, our 6-month good-to-excellent outcome rate (68.2%) is comparable to studies from Europe and North America, where rates range from 65% to 75% depending on the population and implant choice [12]. However, delayed access to surgery and limited rehabilitation facilities in resource-constrained settings like ours may influence these outcomes.

This study had a few limitations. The sample size, although sufficient for preliminary analysis, may limit the generalizability of findings. Additionally, long-term outcomes beyond 6 months were not assessed, which may be relevant in evaluating permanent functional impairment. Finally, variability in surgical technique and postoperative rehabilitation protocols across different centers might have introduced heterogeneity in the results.

Surgical fixation of intertrochanteric fractures in elderly patients yields satisfactory functional outcomes when appropriate implant selection and timely surgical intervention are combined with early rehabilitation. PFN appears superior for unstable fractures, while DHS remains effective for stable configurations. Comorbidities significantly impact recovery and should be considered in perioperative planning. This study underscores the need for standardized care pathways and geriatric co-management models to optimize outcomes in this vulnerable population.

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