Radiological Outcomes of Reamed Short Proximal Femoral Nailing in Intertrochanteric Fractures in Patients Aged 50 Years and Above.

INTRODUCTION: Intertrochanteric fractures in elderly individuals require stable fixation to achieve union, maintain alignment, and prevent post-operative collapse. Although proximal femoral nailing (PFN) provides reliable fixation in most cases, loss of reduction may still occur during fracture healing, leading to alteration in the femoral neck-shaft angle (NSA) and horizontal femoral offset, thereby affecting hip biomechanics and gait. AIMS: The aim of the study was to evaluate the early radiological outcomes of reamed short PFN in intertrochanteric fractures among patients aged 50 years and above, with special emphasis on maintenance of reduction and biomechanical predictors of reduction loss. MATERIALS AND METHODS: A prospective observational study was conducted on 30 patients aged ≥50 years with intertrochanteric femur fractures treated with reamed short PFN over a period of 18 months. Standardized radiographs were obtained preoperatively, immediately postoperatively, and at 3 months follow-up. Measurements were performed using Digimizer software. Radiological parameters included femoral NSA, horizontal femoral offset, cortical reduction quality, canal filling ratio (CFR), and anterior femoral bowing angle. Loss of reduction was defined using a composite criterion comprising ≥5° decrease in NSA, ≥4 mm increase in femoral offset, or deterioration in cortical reduction pattern. RESULTS: Radiological union at 3 months was achieved in 28 patients (93.3%). Loss of reduction was observed in 5 patients (17.9%), whereas 23 patients (82.1%) maintained stable alignment. Mean NSA decreased significantly from 130.04° ± 4.61° immediately postoperatively to 128.64° ± 4.79° at 3 months (P = 0.005). Horizontal femoral offset increased from 38.18 ± 6.07 mm to 38.96 ± 6.03 mm (P = 0.040). Patients with loss of reduction demonstrated significantly lower CFR values in both anteroposterior and lateral planes and greater anterior femoral bowing compared to patients with maintained reduction (P < 0.001). CONCLUSION: Reamed short PFN achieved a 93.3% radiological union rate, with maintenance of reduction in 82.1% of patients. Lower CFR and greater anterior femoral bowing were significant predictors of reduction loss.