Intertrochanteric fractures are frequently operated with cephalomedullary nails among hip especially in the elderly and biomechanics of hip may change due to sliding compression which can lead to abduct or muscle weakness. The aim of this study is to calculate the abductor muscle weakness in intertrochanteric fractures treated with the proximal femoral nail in elderly patients and to correlate it with neck-shaft angle and type of fracture as per Evans classification as limited studies are available for the same. A total of 106 patients were included in the study. Out of 106 consecutive patients, after application of the exclusion criteria, 80 patients were included in our study. The study included 46 males (52.5%) and 34 females (47.5%). As per Evans classification, 15 patients (18.7%) were type 3, 22 patients (27.5%) were type 4, and 43 patients (53.7%) were type 5. On evaluation with modified McKay Criteria, 55 patients (68.7%) had excellent, 10 patients (12.5%) had good, 8 patients (10%) had fair, and 7 patients (8.7%) had poor outcomes. Taking significance value P<0.005, on a statistical analysis of the neck-shaft angle with abductor strength as per McKay criteria, we found a significant correlation with P<0.005. However, no significant correlation was found between the fracture pattern and abductor muscle strength. We can conclude that the restoration of the neck-shaft angle of the femur is an important factor for the strength and recovery of abductor muscles. Proximal Femoral Nail restores neck-shaft angle to near normal irrespective of the fracture angle, hence helps restores almost normal functionality in elderly patients with intertrochanteric fractures.

Akshay Dhanda is a distinguished sports medicine and joint replacement surgeon with expertise in upper limb arthroscopy and joint replacement surgery. He completed his MBBS from KMC, Manipal, and earned his MS. in orthopaedics from MMC & RI, Mysore, where he was awarded the gold medal for his outstanding performance. He further honed his skills with a Fellowship in sports medicine and joint replacement in Bangalore, India, and an additional fellowship in upper limb arthroscopy in South Korea. He also holds a Fellowship in pain management and a certification in healthcare management from the Indian School of Business, Hyderabad. His fields of interest include arthroscopy, joint preservation surgery, joint replacement, and cartilage preservation. With nearly 20 publications to his name, he is recognized for his contributions to the field of orthopaedics and sports medicine.