To compare efficacies of closed reduction and internal fixation with proximal femur nail antirotation (CRIF-PFNA) and hemiarthroplasty with bipolar femoral head prosthesis (HA-BFHP) for geriatric unstable intertrochanteric fractures by combining the Parker mobility score with the Harris hip score.

Ninety-two patients aged ≥65 years old with Evans-Jensen classification Ⅲ~Ⅴ low energy unilateral femoral unstable intertrochanteric fracture admitted to Beijing Longfu Hospital during the selected time span were included as the study subjects; the patients with other severe hip diseases, lower limb fractures at other sites, pathological bone fractures and diseases not suitable for surgery within 48 h were excluded. Forty-six of whom received the treatment of closed reduction proximal femoral anti-screwing intramedullal nail internal fixation (CRIF-PFNA). Another 46 patients underwent double head artificial femoral head replacement (HA-BFHP). Clinical follow-up was performed for two years. The Harris hip score and Parker mobility score were used, and repeated measure ANOVA was used to evaluate and compare the recovery of patients with different operations.

Compared with HA-BFHP, the operation of CRIF-PFNA was relatively simple, the time was short, the bleeding was less, but the patient's bed recovery period was longer. At three months after surgery, patients treated with CRIF-PFNA had lower Harris hip scores (t=−8.88, P<0.001) and greater reductions in Parker mobility scores (t=2.58, P=0.013) compared with those treated with HA-BFHP. There was no significant difference in Harris hip score between the two groups at six, 12 and 24 months after surgery (t=1.31, 0.52, 0.96, all P>0.05). However, the reduction value of Parker activity score in the CRIF-PFNA group at 12 and 24 months after surgery (compared with the onset of fracture) was lower than that in the HA-BFHP group, and the difference was statistically significant (t=2.29, 2.18, both P<0.05).

The two surgical methods have their own merits and demerits in treating geriatric unstable intertrochanteric fractures, in which HA-BFHP is conducive to rapid postoperative recovery to a relatively ideal status, and CRIF-PFNA has lower overall surgical risk, wider applicability, and can achieve better long-term recuperation for non-serious osteoporosis patients.