Pertrochanteric Femur Fractures in Adults Younger Than 65: A Retrospective Analysis of Outcomes After Proximal Femoral Nailing

Objective: This study aimed to evaluate fracture healing patterns and factors affecting outcomes in patients under 65 years of age who were treated with proximal
femoral nail (PFN) fixation for pertrochanteric femur fractures.
Materials and Methods: A retrospective analysis was conducted on 158 patients under 65 years of age treated with PFN fixation between 2013 and 2024. Demographic
data, trauma mechanisms, fracture classifications, reduction quality, bone quality, presence of femoroacetabular impingement (FAI), osteoarthritis progression, and
complication rates were evaluated.
Results: The mean age was 51.1 years and 63.3% of the patients were male. High-energy trauma was the leading mechanism (43%), particularly in male patients
(p<0.01). Good reduction quality was significantly associated with earlier mobilization (p<0.05). FAI lesions were present in 39.9% of patients, and cam- or pincer-type
FAI was more frequently associated with low-energy trauma (p=0.06). Osteoarthritis progression was observed in 35.4% of patients, but no significant associations
were found with reduction quality, bone quality, or the presence of coxa valga. The complication rate was 24.1%, with heterotopic ossification being the most common
type of complication. Smoking was significantly associated with delayed healing (p<0.05).
Conclusions: Pertrochanteric femur fractures in patients younger than 65 are more commonly associated with high-energy trauma and occur more frequently in male
individuals. Reduction quality was significantly associated with earlier mobilization. Although preoperative FAI was more frequently observed in patients with lowenergy
trauma, the association was not statistically significant. These findings highlight the importance of fracture characteristics and reduction quality for functional
recovery in younger patients.