Fracture-Pattern-Guided Implant Selection in Extracapsular Proximal Femoral Fractures: A Descriptive Single-Centre Study of Dynamic Hip Screw and Proximal Femoral Nail Fixation in Older Adults.

introductionDynamic hip screw (DHS) and proximal femoral nail (PFN) are both used to fix extracapsular proximal femoral fractures, with implant selection in routine practice typically guided by fracture morphology. This study describes perioperative outcomes and the pattern of implant selection in older adults treated at a single UK trauma centre. MATERIALS AND

methodsThis single-centre retrospective descriptive study included all eligible patients aged 65 years or older undergoing fixation of extracapsular proximal femoral fractures during the 12-month study period (1 January to 31 December 2024); all eligible procedures during this period were included, and no sample-size calculation was performed. Data included demographics, American Society of Anesthesiologists (ASA) grade, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture classification, time to surgery and mobilisation, length of stay, mechanical complications, reoperation, mortality, and discharge destination. As the groups differed in fracture pattern, with numerical imbalances in age and ASA grade, and were not randomised, statistical comparisons are presented descriptively and should be regarded as exploratory only.

resultsOf 101 procedures in 100 patients (mean age 83.2 years), 78 were treated with DHS and 23 with PFN. Implant selection closely tracked fracture pattern: 98.7% of DHS procedures were for AO/OTA 31-A1/A2 fractures vs 82.6% of PFN procedures for 31-A3 fractures (Fisher's exact p < 0.001). Mobilisation within 24 hours occurred in 64% (DHS) and 48% (PFN); the median length of stay was 20 vs 15.5 days (mean 22.4 vs 28.5 days, the latter skewed by a single 137-day PFN outlier); mechanical complications occurred in five DHS and two PFN patients; reoperation in three and two; 30-day mortality was 7.7% vs 13.0%; and one-year mortality was 39.7% vs 17.4%. Outcome estimates were imprecise due to the small PFN group size and substantial baseline differences between treatment groups. DISCUSSION: Because implant selection tracked fracture stability rather than randomisation, the groups differed fundamentally in case mix and cannot be treated as comparable cohorts. Baseline differences in fracture morphology and stability, and in comorbidity (most patients were ASA III/IV), offer a plausible, though unadjusted and unconfirmed, alternative explanation for observed outcome differences; the exploratory comparisons presented should not be read as evidence of comparative implant performance.

conclusionsImplant selection was guided by fracture morphology, consistent with NICE guidance. Comparative effectiveness of DHS vs PFN was not assessed in this non-randomised, fracture-pattern-selected cohort.