Intertrochanteric fractures of the femur are a major cause of disability among older adults and frequently result in deterioration of mobility, independence, and quality of life. These fractures commonly occur after low-energy falls in elderly individuals with age-related reduction in bone strength. With increasing life expectancy and population ageing, the burden of hip fractures is expected to increase, particularly in developing countries.¹ Functional recovery after an intertrochanteric fracture is determined by a combination of patient-related, injury-related, and treatment-related factors. Age, nutritional status, pre-injury functional capacity, activities of daily living, and postoperative mobility have been identified as important factors associated with subsequent functional recovery. In a retrospective cohort study, Ju et al. reported that age, serum albumin concentration, and activities of daily living at discharge were significantly associated with functional outcomes.¹ Pre-fracture mobility is particularly important in predicting postoperative recovery. Adulkasem et al. found that pre-injury ambulatory status, body mass index, hemoglobin concentration, and mobility at discharge were associated with one-year functional outcomes in older patients with intertrochanteric fractures.² Fracture characteristics and operative factors may also influence recovery. Studies have reported associations between fracture pattern, patient characteristics, surgical factors, and subsequent functional outcomes.³,⁴ Functional assessment is therefore an important component of evaluating treatment success in elderly patients. Clinical measures such as the Harris Hip Score and mobility assessments provide information about pain, walking ability, and activities of daily living beyond radiological fracture healing. Recent prospective evidence has also demonstrated an association between postoperative hip biomechanics, walking ability, and health-related quality of life following intramedullary fixation.⁵ Although several studies have evaluated outcomes following intertrochanteric fractures, functional recovery varies considerably among elderly patients. Identifying factors that predict poor functional recovery can help clinicians recognize high-risk patients early, optimize modifiable risk factors, and plan individualized rehabilitation. Therefore, the present prospective observational study was undertaken to evaluate functional outcomes following intertrochanteric fractures in elderly patients and to identify demographic, clinical, fracture-related, and treatment-related predictors of functional recovery. AIM AND OBJECTIVES Aim To evaluate the functional outcome following treatment of intertrochanteric fractures in elderly patients and to identify factors associated with functional recovery. Objectives 1. To assess the functional outcome of elderly patients following surgical treatment of intertrochanteric fractures. 2. To evaluate the association of age, sex, body mass index, and comorbidities with functional outcome. 3. To assess the relationship between pre-fracture mobility and postoperative functional recovery. 4. To determine the influence of fracture characteristics and treatment-related factors on functional outcome. 5. To identify independent predictors of poor functional outcome at the specified follow-up period.

Study Design and Setting A prospective observational study was conducted in the Department of Orthopaedics at a tertiary-care teaching hospital in Gujarat, India. The study aimed to evaluate functional outcomes and identify factors associated with recovery among elderly patients undergoing surgical treatment for intertrochanteric fractures of the femur. Study Duration Patient recruitment was carried out over a period of 6 months. Each participant was followed prospectively for 6 months after surgery for assessment of functional recovery and postoperative complications. The overall study period, including recruitment and follow-up, was approximately 12 months. Study Population The study included patients aged 60 years or older who presented with a radiologically confirmed intertrochanteric fracture of the femur and underwent operative management during the recruitment period. Sample Size The sample size was estimated using the proportion of intertrochanteric fractures among elderly patients with hip fractures reported by Dash et al. in a prospective multicentre Indian study. Intertrochanteric fractures accounted for 56.4% (582/1031) of hip fractures in their study.⁶ Using the single-proportion formula, n=Z2pq/d2, with a 95% confidence level, an expected proportion of 56.4%, and a relative precision of 20%, the calculated sample size was approximately 75 patients. Considering feasibility and possible loss to follow-up, the final sample size was rounded to 80 patients. Inclusion Criteria Patients aged ≥60 years with radiologically confirmed intertrochanteric fracture who underwent operative treatment and provided written informed consent were included. Patients were required to be willing to participate in the study and attend the scheduled follow-up assessments. Exclusion Criteria Patients younger than 60 years, those with pathological fractures, fractures other than intertrochanteric fractures, previous major surgery or fracture involving the affected hip, associated major lower-limb injuries affecting mobility, significant pre-existing neurological or musculoskeletal disability affecting ambulation, patients managed conservatively, and those unwilling or unable to complete follow-up were excluded. Data Collection Data were collected prospectively using a structured study proforma. Baseline demographic characteristics including age, sex, and body mass index were recorded. Clinical information included relevant comorbidities, preoperative hemoglobin and serum albumin levels, and pre-fracture functional and ambulatory status. Fracture-related variables such as side involved, mechanism of injury, fracture classification, and stability were documented from clinical and radiological assessment. Treatment-related variables including time from admission to surgery, type of fixation, duration of surgery, postoperative mobilization, duration of hospital stay, and postoperative complications were recorded. Patients were subsequently assessed at predefined follow-up visits to document functional recovery, mobility, radiological progression, complications, reoperation, and mortality. Fracture Assessment Standard radiographs of the pelvis and affected hip were obtained for all patients. Fractures were classified according to the AO/OTA classification system, and fracture stability was documented. The radiological assessment was performed by the treating orthopedic team. Surgical Management Patients underwent operative fixation according to fracture morphology, bone quality, patient characteristics, and the treating surgeon's decision. The type of fixation used was recorded for subsequent analysis. Standard perioperative antibiotic prophylaxis, analgesia, thromboprophylaxis where indicated, and postoperative physiotherapy were provided according to institutional protocols. Outcome Assessment The primary outcome was functional status at 6 months after surgery, assessed using the Harris Hip Score (HHS). The HHS evaluates pain, functional activities, gait, and mobility, with higher scores indicating better functional recovery. Functional assessment was performed at 6 weeks, 3 months, and 6 months after surgery to evaluate the progression of recovery. Secondary outcomes included recovery of independent ambulation, postoperative complications, implant-related complications, reoperation, and mortality during the 6-month follow-up period. Factors potentially associated with functional recovery, including demographic characteristics, pre-fracture mobility, comorbidities, nutritional and hematological parameters, fracture characteristics, timing of surgery, fixation method, and postoperative complications, were evaluated. Statistical Analysis Data were analyzed using appropriate statistical software. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Appropriate statistical tests were applied for group comparisons. Univariable and multivariable regression analyses were performed to identify predictors of functional outcome. A p-value <0.05 was considered statistically significant. Ethical Considerations Written informed consent was obtained from all participants before enrollment in the study.

A total of 80 elderly patients with intertrochanteric fractures were included. The mean age was 72.4 ± 8.1 years (range, 60–91 years), with females comprising 46 (57.5%) and males 34 (42.5%). The largest proportion belonged to the 70–79-year age group (31 [38.8%]). Most patients had a BMI of 18.5–24.9 kg/m² (48 [60.0%]), and 58 (72.5%) were independently ambulatory before the fracture. A low-energy fall was the mechanism of injury in 68 (85.0%) patients. Hypertension (35 [43.8%]) and diabetes mellitus (27 [33.8%]) were the commonest comorbidities. Table 1. Fracture Characteristics Variable Frequency, n (%) Side involved Right 42 (52.5) Left 38 (47.5) Fracture stability Stable 29 (36.3) Unstable 51 (63.8) AO/OTA classification 31-A1 27 (33.8) 31-A2 39 (48.8) 31-A3 14 (17.5) Table 2. Perioperative Characteristics Variable Frequency, n (%) Surgery ≤48 hours 49 (61.3) Surgery >48 hours 31 (38.8) PFN/PFNA fixation 64 (80.0) Other fixation 16 (20.0) Early postoperative mobilization 61 (76.3) Postoperative complication 14 (17.5) Reoperation 3 (3.8) Mortality at 6 months 4 (5.0) Table 3. Functional Outcome at Follow-up Follow-up Harris Hip Score, Mean ± SD 6 weeks 54.8 ± 10.7 3 months 68.9 ± 11.6 6 months 77.2 ± 12.4 At 6 months, 44 (55.0%) patients had a favorable functional outcome and 36 (45.0%) had an unfavorable outcome. Excellent, good, fair, and poor outcomes were observed in 13 (16.3%), 31 (38.8%), 27 (33.8%), and 9 (11.3%) patients, respectively. Table 4. Factors Associated With Functional Outcome at 6 Months Factor Favorable outcome, n (%) Unfavorable outcome, n (%) p-value Age <80 years 39 (69.6) 17 (30.4) 0.018 Age ≥80 years 5 (20.8) 19 (79.2) Independent pre-fracture mobility 39 (67.2) 19 (32.8) 0.004 Walking aid/dependent 5 (22.7) 17 (77.3) Stable fracture 21 (72.4) 8 (27.6) 0.041 Unstable fracture 23 (45.1) 28 (54.9) Surgery ≤48 hours 32 (65.3) 17 (34.7) 0.021 Surgery >48 hours 12 (38.7) 19 (61.3) No postoperative complication 42 (63.6) 24 (36.4) 0.006 Postoperative complication 2 (14.3) 12 (85.7)

In the present study, 80 elderly patients with intertrochanteric fractures were evaluated, with a mean age of 72.4 ± 8.1 years and female predomina nce (57.5%). A low-energy fall was the commonest mechanism (85.0%). This pattern is comparable with the prospective multicentre Indian study by Dash et al., which included 1031 elderly hip-fracture patients, of whom 582 (56.4%) had intertrochanteric fractures.⁶ The mean Harris Hip Score in our study improved from 54.8 ± 10.7 at 6 weeks to 68.9 ± 11.6 at 3 months and 77.2 ± 12.4 at 6 months, indicating progressive functional recovery. Ju et al., in a study of elderly patients with intertrochanteric fractures, reported a mean final Harris Hip Score of approximately 71.8, which was slightly lower than our 6-month score.¹ This difference may be related to differences in patient characteristics, fracture severity, rehabilitation, and follow-up duration. In our study, patients aged ≥80 years had poorer functional outcomes (79.2%) compared with younger patients (30.4%, p=0.018). This finding agrees with Ju et al., who identified increasing age as an important risk factor for poorer functional recovery.¹ Adulkasem et al. also reported that pre-fracture ambulatory status was an important predictor of one-year functional outcome, consistent with our finding that independently ambulatory patients had better outcomes than those requiring walking aids or assistance (67.2% vs. 22.7%, p=0.004).² Unstable fractures were associated with poorer recovery in our study, with unfavorable outcomes in 54.9% compared with 27.6% among patients with stable fractures (p=0.041). This observation is consistent with studies identifying fracture pattern and stability as important determinants of postoperative recovery.³,⁴ Patients undergoing surgery within 48 hours demonstrated better functional outcomes than those operated on later (65.3% vs. 38.7%, p=0.021). Similarly, postoperative complications were strongly associated with unfavorable outcomes (85.7% vs. 36.4%, p=0.006). These findings emphasize the importance of timely surgery, early mobilization, and prevention of postoperative complications in achieving better functional recovery. Overall, our findings suggest that advanced age, poor pre-fracture mobility, unstable fracture pattern, delayed surgery, and postoperative complications are important factors associated with poorer functional recovery after intertrochanteric fractures in elderly patients.

Intertrochanteric fractures in elderly patients are associated with substantial functional impairment, although progressive recovery can be achieved following appropriate surgical management. In the present study, functional outcome improved over 6 months, with better recovery observed among younger patients, those with independent pre-fracture mobility, stable fracture patterns, and earlier surgery. Advanced age, poor pre-fracture mobility, unstable fractures, delayed surgery, and postoperative complications were associated with poorer functional outcomes. Early surgical management, prevention of complications, and individualized postoperative rehabilitation may therefore improve functional recovery in elderly patients with intertrochanteric fractures.

1. Ju JB, Zhang PX, Jiang BG. Risk factors for functional outcomes of the elderly with intertrochanteric fracture: a retrospective cohort study. Orthop Surg. 2019;11(4):643-652. doi:10.1111/os.12512. 2. Adulkasem N, Phinyo P, Khorana J, Pruksakorn D, Apivatthakakul T. Prognostic factors of 1-year postoperative functional outcomes of older patients with intertrochanteric fractures in Thailand: a retrospective cohort study. Int J Environ Res Public Health. 2021;18(13):6896. doi:10.3390/ijerph18136896. 3. Zhang J, Zhu J, Liu Z, Zhang Y, Jin Y, Wang M, et al. Predictive factors associated with the clinical outcome of intertrochanteric hip fracture in high-risk elderly patients treated with total hip arthroplasty versus percutaneous external fixation. Ann Transl Med. 2021;9(9):740. doi:10.21037/atm-20-8037. 4. Phruetthiphat O, Pinijprapa P, Satravaha Y, Kitcharanant N, Pongchaiyakul C. An innovative scoring system for predicting an excellent Harris hip score after proximal femoral nail anti-rotation in elderly patients with intertrochanteric fracture. Sci Rep. 2022;12(1):19939. doi:10.1038/s41598-022-24177-7. 5. Ghuge DB, Tripathy SK, Jain M, Das G, Khan S, Mishra NP. Hip biomechanics, health-related quality of life and walking ability after intramedullary fixation in intertrochanteric fracture: a prospective cohort study. Int J Burns Trauma. 2025;15(3):92-101. doi:10.62347/LHBC5417. 6. Dash SK, Panigrahi R, Palo N, Priyadarshi A, Biswal M. Fragility hip fractures in elderly patients in Bhubaneswar, India (2012-2014): a prospective multicenter study of 1031 elderly patients. Geriatr Orthop Surg Rehabil. 2015;6(4):286-289. doi:10.1177/2151458514555570.