A Prospective Randomized Trial: Does Full Weight Bearing Improve Functional Outcomes in Elderly Patients With Proximal Intramedullary Nailing After an Intertrochanteric Femur Fracture?

IntroductionThis study aimed to compare the functional outcomes and degree of independence in activities of daily living in patients aged >65 years who were treated with a proximal femoral nail (PFN) after an intertrochanteric femur fracture (ITFF) and underwent full and partial load-bearing in the early stage.MethodsOverall, 133 patients who were hospitalized for ITFF and treated with PFN between August 2018 and March 2021 were randomly assigned to two groups. During the follow-up period, 45 patients who underwent partial load bearing (Group 1) and 40 patients who underwent full load bearing (Group 2) were prospectively evaluated. The Harris hip score was used for functional evaluation, and the Barthel index was used to evaluate the degree of independence in activities of daily living.ResultsThe mean age of the patients included in the study was 76.67 +/- 8.62 years. Regarding the comparison among groups in terms of age, sex, direction of fracture, reduction quality, fracture type, tip-apex distance, and surgical risk, there was no statistically significant difference between the two groups (p >= 0.05). Moreover, regarding the comparison in terms of calcium, phosphate, alkaline phosphatase, vitamin D, and keratin levels, which affect bone metabolism, no statistical difference was observed (p >= 0.05). We found that the mean Harris hip score was significantly higher in Group 1 than in Group 2 (Group 1: 76.82 +/- 12.48; Group 2: 67.80 +/- 15.34; p = 0.004). Moreover, 73.3% (n=33) and 42.5% (n=17) of patients in Groups 1 and 2 were fully independent or mildly dependent, respectively. We also found that the independence status was significantly better in Group 1 (p = 0.004).ConclusionMobilization of older patients treated with PFN after ITFF using partial load-bearing protocols in the early postoperative period positively impacts hip function and the ability to perform activities of daily living independently.