Effect of Surgery Within 48 hours on Early Balance, Gait, and Fall Risk in Elderly Intertrochanteric Fracture Patients

Abstract

Background: Intertrochanteric femoral fractures in elderly patients are linked to impaired mobility, increased fall risk, and high mortality. Early surgical intervention within 48 hours is recommended to reduce complications, but its effect on gait and balance is unclear. This study evaluated the impact of early versus delayed surgery on gait, balance, and clinical outcomes in elderly patients treated with cephalomedullary nails. Methods: We retrospectively analyzed 193 patients aged ≥60 years with closed intertrochanteric fractures treated between January 2018 and January 2025. Patients were categorized as early (≤48 hours, n = 111) or delayed (>48 hours, n = 82) surgery. Gait and balance at 3 months postoperatively were assessed using the timed up and go test, five times sit-to-stand test, and functional reach test. Secondary outcomes included hospital stay, mortality, complications, and functional scores (Harris hip score, de Morton mobility index, Barthel index). Results: Early surgery was associated with markedly better five times sit-to-stand performance (34.5 ± 9.8 vs. 45.0 ± 11.2 seconds; P = 0.007) and lower mortality (5.4% vs. 14.6%; P = 0.029). Trends toward improved timed up and go (40.6 ± 12.3 vs. 59.4 ± 15.7 seconds; P = 0.100) and functional reach test (17.2 ± 4.5 vs. 13.6 ± 3.9 cm; P = 0.115) were observed. Complication rates (11.7% vs. 15.9%; P = 0.405) and other functional scores were similar. Both groups remained at high fall risk per gait and balance assessments. Conclusion: Surgery within 48 hours improves lower-limb function and reduces mortality in elderly patients with intertrochanteric fractures, but persistent fall risk highlights the need for postoperative fall prevention strategies.