Evaluation of Orthopedic Outcomes of Proximal Femoral Nailing for Intertrochanteric Fractures and Predictive Value of Pre-operative Glycemic Status, Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio: A Prospective Study.

ITRODUCTION: Intertrochanteric femur fractures are common in the elderly and are associated with significant morbidity. Proximal femoral nail (PFN) is widely used for fixation; however, outcomes may be influenced by pre-operative metabolic and inflammatory status. This study evaluated functional outcomes of PFN and the predictive value of glycemic control, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). MATERIAL AND METHODS: This prospective study included 90 patients with intertrochanteric fractures treated with PFN. Pre-operative Glycated hemoglobin (HbA1c), NLR, and PLR were recorded. Patients were followed for 6 months and assessed using the Harris Hip Score (HHS). Functional outcomes, complications, and predictors of poor outcome were analyzed using t-test, Chi-square test, logistic regression, and receiver operating characteristic analysis. RESULTS: The mean age was 69.4 ± 10.8 years. At 6 months, the mean HHS was 85.2 ± 10.7, with 73.3% patients achieving excellent or good outcomes. Delayed union was the most common complication (6.7%). Patients with fair/poor outcomes had significantly higher HbA1c, NLR, and PLR (P < 0.01). HbA1c ≥7.1%, NLR >4.6, and PLR >168 were independent predictors of poor outcome. NLR showed the highest predictive ability (area under the curve 0.812). CONCLUSION: PFN provides favorable functional outcomes in intertrochanteric fractures. However, elevated pre-operative HbA1c, NLR, and PLR are associated with poorer outcomes and may serve as useful predictors for risk stratification and perioperative optimization.