Proximal femoral nail versus dynamic hip screw in treatment of intertrochanteric fractures: a systematic review

Intertrochanteric femoral fractures are common in the elderly and typically require internal fixation. This systematic review compared the clinical and radiological outcomes of the proximal femoral nail (PFN) and the dynamic hip screw (DHS) by analyzing 25 studies published between 2000 and 2024 across PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. Key parameters included operative time, intraoperative blood loss, complication and reoperation rates, union time, and functional outcomes measured by the Harris hip score (HHS). Pooled evidence showed that PFN offers significant advantages in unstable fractures (AO/OTA 31-A2 and A3), demonstrating shorter operative time, reduced blood loss, lower implant-failure and reoperation rates, faster radiological union, and higher HHS at 3- and 6-month follow-up compared with DHS. DHS produced comparable results in stable fracture patterns (AO/OTA 31-A1) but was associated with higher mechanical complications in complex cases. Although PFN requires greater technical expertise and carries a small risk of iatrogenic femoral shaft fracture, its intramedullary design provides biomechanical superiority that supports early mobilization and improved functional recovery, especially in elderly osteoporotic patients. Surgical decision-making should therefore consider fracture stability, patient comorbidities, and surgeon experience to optimize outcomes.