Application value of auxiliary anterolateral hip mini-incision combined with traction-free reduction and internal fixation in complex intertrochanteric fractures in older adult patients

Purpose To evaluate the efficacy of anterolateral hip mini-incision combined with traction-free reduction and internal fixation for older adult with complex intertrochanteric fractures. Methods Older adult patients (>60 years) with low-energy osteoporotic intertrochanteric fractures who underwent proximal femoral nail antirotation (PFNA) between 2018 and 2023 were enrolled. A total of 41 patients were randomly assigned to the observation group ( n = 18, anterolateral mini-incision + traction-free fixation) or control group ( n = 23, traction table-assisted fixation). Primary outcomes included anesthesia duration and reduction quality (Fogagnolo criteria). Secondary outcomes were operative duration, intraoperative blood loss, fluoroscopic exposures, postoperative Visual Analogue Scale (VAS) scores (3rd/10th days), Harris Hip Score (HHS), incision complications, perioperative mortality, and 6-month adverse events (implant cutout/displacement/breakage). Results All patients completed surgery and 6-month follow-up without incision complications or internal fixation failure. The observation group had significantly shorter anesthesia duration (73.17 ± 8.79 vs. 96.22 ± 10.50 min) and less intraoperative blood loss (180 ± 21.2 vs. 210 ± 19.7 mL, both P < 0.05). No significant differences were noted in operative duration (62.39 ± 7.52 vs. 58.17 ± 8.68 min), fluoroscopic exposures (15 ± 3.1 vs. 13 ± 2.3), postoperative VAS scores (Day 3: 4.33 ± 0.77 vs. 4.34 ± 0.96; Day 10: 3.89 ± 0.58 vs. 4.17 ± 0.78), reduction excellent-good rate (84% vs. 88%), or HHS excellent-good rate (92% vs. 88%, all P > 0.05). Conclusion Anterolateral hip mini-incision with traction-free supine reduction and fixation is a reliable technique for older adult intertrochanteric fractures. It obviates traction table dependency, shortens anesthesia duration, reduces anesthetic risks in older adult patients, and achieves satisfactory reduction and hip function recovery without increasing blood loss or fluoroscopic exposure. This approach avoids traction table-related complications and is suitable for institutions lacking traction table facilities.