Early functional outcomes of proximal femur fractures treated with proximal femoral nailing in a tertiary trauma center

Abstract

Background/Aim: Proximal femur fractures are common and often debilitating, particularly in older adults with osteoporosis and a high risk of falls. In younger individuals, these injuries usually result from high-energy trauma. Proximal femoral nailing has gained acceptance as a reliable fixation method that may enable early mobilization and functional recovery. This study evaluated the early functional outcomes and complications of proximal femoral nailing in patients managed at a tertiary trauma center. Methods: This prospective cohort included 55 patients with proximal femur fractures treated with proximal femoral nailing; 46 patients completed follow-up and were included in the final analysis. Functional outcomes were assessed over 6 months using the Lower Extremity Functional Scale and the Short Form-36 health survey, together with clinical and radiological evaluation. Data were analyzed using IBM SPSS Statistics for Windows, version 23. Continuous variables were summarized as mean (SD), and categorical variables as frequencies and percentages. Appropriate parametric and nonparametric tests were used, with statistical significance set at P < 0.05. Results: The mean age was 57.9 (13.0) years, and the male-to-female ratio was 1.7:1. The radiological union rate was 91%, with a mean time to union of 3.9 (0.2) months. Lower Extremity Functional Scale and Short Form-36 scores improved progressively during follow-up. Poorer functional outcomes were associated with comorbidities, pre-injury use of walking aids, female sex, older age, higher American Society of Anesthesiologists grade, and surgery delayed beyond 48 hours. Complications occurred in 13% (n = 6) of patients, predominantly superficial surgical site infections. Surgical site infection was associated with comorbidities (P = 0.040) and showed a borderline association with increasing age (P = 0.048). Conclusion: Proximal femoral nailing provided reliable fixation, a high union rate, and meaningful early functional recovery in this cohort. Patient baseline characteristics and timing of surgery were associated with recovery. Larger multicenter studies with longer follow-up are needed to confirm these findings.