Nailing the Outcome: A Comparative Study of Proximal Femoral Nail Anti-Rotation-II and Trochanteric Fixation Nail in Unstable Intertrochanteric Femur Fractures

Abstract

Introduction: Intertrochanteric femur fractures are among the most common injuries in the elderly population and represent a major public health issue. Treatment aims to achieve stable fixation that allows early mobilization and minimizes complications. The choice of implant plays a critical role in clinical outcomes, particularly in unstable fracture patterns.

Objectives: The aim of this study was to compare the intraoperative parameters, functional outcomes, union times, and complications between proximal femoral nail anti-rotation-II (PFNA-II) and trochanteric femur nail (TFN) in patients with unstable intertrochanteric femur fractures.

Materials and methods: A prospective, randomized, and comparative study was conducted in a tertiary care center over a period of 18 months. One hundred patients aged 50-85 years with Boyd and Griffin type III fractures were divided into two groups. Group A (n = 50) was treated using TFN, while Group B (n = 50) received PFNA-II. Surgical techniques, post-operative care, and rehabilitation protocols were standardized. Data on operative time, intraoperative blood loss, union duration, Harris Hip scores (HHS), and complications were collected and statistically analyzed.

Results: The PFNA-II group had shorter operative times (Mean 65.5 min. vs. 71.5 min) and less blood loss (253 ± 36.4 mL vs. 275 ± 35.1 mL) than the TFN group. Average union time was similar between groups. Mean HHS at 6 months was higher in the PFNA-II group (67.83 ± 8.05) than the TFN group (71.72 ± 7.45), though the difference was not statistically significant. PFNA-II also showed a lower incidence of implant-related complications.

Conclusion: PFNA-II offers certain intraoperative advantages and trends toward better functional outcomes and fewer complications, but the differences with TFN were not statistically significant. Both implants are viable for the treatment of unstable intertrochanteric fractures.

Keywords: Intertrochanteric fracture; functional outcome; intramedullary fixation; proximal femoral nail anti-rotation-II; trochanteric femur nail.

Fig 1

Study design.

Fig 2

Pre-operative X-ray

Fig 3

Immediate post-operative X-ray

Fig 4

POD 6 weeks

Fig 5

POD 3.5 months

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POD 6 months

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Pre-operative X-ray

Fig 8

Immediate post-operative X-ray

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POD 6 weeks

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POD 3.5 months

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POD 6 months