Publication:

Functional outcomes of augmented intramedullary nailing for unstable intertrochanteric fractures with lateral wall deficiency in elderly patients with Dorr type C femur: a prospective observational study

Background Managing unstable intertrochanteric femur fractures in older adults remains challenging, particularly when lateral wall disruption coexists with severe osteoporosis. In patients with Dorr type C femoral morphology, compromised bone quality further reduces fixation stability and increases the risk of mechanical failure. Although intramedullary nailing is widely accepted for unstable fracture patterns, additional lateral wall reconstruction using an extramedullary implant may provide enhanced structural support. Evidence regarding the clinical effectiveness of this combined fixation strategy in elderly osteoporotic patients remains limited. This study evaluated the functional and radiological outcomes of augmented intramedullary fixation in this high-risk population.

Methods A prospective observational study was conducted in 30 patients aged 65–75 years presenting with unstable intertrochanteric fractures associated with lateral wall deficiency and Dorr type C femoral morphology. All participants underwent fixation using a proximal femoral intramedullary nail supplemented with an extramedullary implant. Clinical assessment, radiographic evaluation and functional outcome measurement were performed at 2 weeks, 2 months and 6 months after surgery. Functional recovery was assessed using the Harris Hip Score (HHS), while fracture union, postoperative complications and the timing of weight bearing were also recorded.

Results The mean patient age was 69.5±2.59 years and females represented 53.3% of the study population. Low-energy falls accounted for most injuries (80%). Radiographic union was achieved within 15–20 weeks in 80% of patients. Partial weight bearing commenced within 5–6 postoperative days in 53.3% of cases. Functional performance improved steadily during follow-up, with the mean Harris Hip Score increasing from 47.73±3.08 at two weeks to 86.60±5.96 at six months (p<0.001). At final evaluation, excellent and good functional outcomes were observed in 46.7% and 43.3% of patients, respectively. An uncomplicated postoperative course was documented in 86.7% of patients, while implant-related complications were uncommon.

Conclusions Augmentation of intramedullary fixation with an extramedullary implant provides stable fixation for unstable intertrochanteric fractures with lateral wall deficiency in elderly patients with Dorr type C femora. The technique supports early mobilisation, facilitates timely fracture healing and results in favourable functional recovery with a low incidence of postoperative complications. These findings suggest that augmented fixation is a reliable treatment option for complex osteoporotic intertrochanteric fractures.