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Objectives and questions: To investigate the association between postoperative reduction quality and recurrent falls within one year after surgery in elderly patients with intertrochanteric fractures, and to explore whether reduction quality is an independent risk factor for recurrent falls.

Material and methods: This retrospective study included elderly patients with intertrochanteric fractures who underwent surgical treatment between 2019 and 2023. Reduction quality was assessed radiographically and categorized as positive, anatomical, or negative reduction. Recurrent falls within one year after discharge were recorded through follow-up. Demographic and clinical variables were collected. Univariate analyses were performed, followed by multivariable logistic regression to evaluate the independent association between reduction quality and recurrent falls.

Results: A total of 228 patients were included, with 120 patients in the positive reduction group, 80 in the anatomical reduction group, and 28 in the negative reduction group. There were no significant differences in age or sex among the three groups (P > 0.05). Compared with the positive and anatomical reduction groups, the negative reduction group had significantly lower self-care ability scores, hip function scores, and SPPB scores, and a significantly higher sarcopenia risk score (all P < 0.05). The incidence of recurrent falls was significantly higher in the negative reduction group (P = 0.041). AO fracture type differed significantly among reduction groups (P < 0.001). Spearman correlation analysis showed that vertical displacement was negatively correlated with horizontal displacement (r = −0.227, P = 0.001), and horizontal displacement was positively correlated with displacement difference (r = 0.396, P < 0.001). Radiographic parameters were not significantly correlated with reduction quality (P > 0.05). During follow-up, reduction quality deteriorated in 16 patients (7.0%), including 7 patients (3.1%) who progressed from positive to negative reduction and 9 patients (3.9%) who deteriorated from anatomical to negative reduction. AO fracture type was not significantly associated with reduction deterioration (χ² = 4.77, P = 0.312). Multivariable logistic regression analysis demonstrated that reduction quality was independently associated with recurrent falls (overall P = 0.011). Compared with negative reduction, positive reduction showed an increased risk of recurrent falls (OR = 3.49, 95% CI 0.80–15.19), although the difference did not reach statistical significance. Age, sex, AO fracture type, and SPPB score were not independently associated with recurrent falls.

Discussion and conclusions: Poor postoperative reduction quality is associated with an increased risk of recurrent falls in elderly patients with intertrochanteric fractures. Optimizing reduction quality may contribute not only to fracture healing but also to fall prevention after discharge. These findings highlight the importance of surgical quality in improving postoperative safety in the elderly population.