Surgical Management of Evans-Jensen Type IV Femoral Intertrochanteric Fractures in Elderly Patients Aged 65 and Above: A Comparative Study of THA and PFNA

AbstractBackground The optimal surgical approach for Evans-Jensen IV type intertrochanteric fractures in individuals aged 65 and above remains unclear. This study aimed to retrospectively compare early limb function and quality of life in patients treated with total hip arthroplasty (THA) versus proximal femoral nail antirotation (PFNA). We hypothesized no significant differences in complications and postoperative outcomes between the two procedures. Methods A retrospective analysis included patients aged 65 and above with Evans-Jensen IV fractures treated between 2020 and 2023. Patients were categorized into PFNA and THA groups, and various parameters were recorded, including surgery duration, intraoperative blood loss, postoperative ambulation, partial weight-bearing time, Harris hip scores, SF-36 scale scores, and complications. Results Forty patients (20 PFNA, 20 THA) were analyzed. THA had longer surgery duration and greater blood loss (both p < 0.001). THA demonstrated earlier postoperative ambulation and partial weight-bearing (both p < 0.001) and higher Harris hip and SF-36 scores at 1, 3, and 6 months (all p < 0.05). Overall complication rates did not significantly differ (p = 0.41). Conclusion For Evans-Jensen IV fractures in individuals aged 65 and above, THA is recommended, enabling earlier rehabilitation, faster recovery, and improved postoperative quality of life.