Abstract: Objective To investigate the clinical efficacy of intramedullary reduction technique combined with proximal femoral nail anti-rotation (PFNA) internal fixation in the elderly patients with irreducible varus intertrochanteric fractures. Methods The clinical data of 22 elderly patients with irreducible varus intertrochanteric fractures from September 2022 to September 2024 in Geriatric Hospital of Nanjing Medical University were retrospectively analyzed. The PFNA main nail was utilized for intramedullary compression reduction during surgery. Postoperative fracture reduction quality was evaluated by anteroposterior and lateral radiographs of the proximal femur within 48 hours after the operation, while hip function was assessed by Harris Hip Score (HHS) at final follow-up. Results The mean operative time was 60.5±11.5 min, and the average blood loss was 131.8±57.5 mL. The average time for fractures healing was 4.6±0.9 months. All patients were followed up for an average of 10.8 months. HHS at final follow-up showed excellent in 16 cases, good in 4 cases, and poor in 2 cases, with an excellent/good rate of 90.9% (20/22). Fracture reduction quality was graded as good in 14 cases, acceptable in 5 cases, and poor in 3 cases. Positive coronal buttress was observed in 15 cases and neutral buttress in 7 cases. Conclusions Intramedullary reduction technique demonstrates satisfactory outcomes in the elderly patients with irreducible varus intertrochanteric fractures, which can effectively correct the inversion deformity on the coronal plane and achieve satisfactory reduction effect.

Key words: intertrochanteric fracture, varus deformity, proximal femoral nail antirotation, internal fixation, intramedullary reduction, aged