Comparative Study of the Clinico-Radiological Outcomes of Fixation of Unstable Intertrochanteric Fractures with Standard Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation for Asia (PFNA2)

Introduction: Intertrochanteric fractures are common in elderly individuals with osteoporosis, where surgical fixation is crucial for reducing complications and promoting early mobilization. Proximal femoral nails (PFN) have been widely used for unstable intertrochanteric fractures, but complications such as screw cut-out and rotational instability persist. The PFNA2, featuring a helical blade, has been developed to improve fixation in osteoporotic bone by enhancing stability. Materials and Methods: A prospective comparative study was conducted on 50 patients with unstable intertrochanteric fractures (AO 31.A2 and 31.A3). Group A (n=25) underwent surgical fixation using PFN, while Group B (n=25) received PFNA2. Patients were followed for six months, with clinical outcomes assessed using the Harris Hip Score and radiological outcomes by bone union time. Both groups had similar demographic and fracture characteristics. Results: The mean age of patients was 60.75 years in Group A and 64.37 years in Group B. PFNA2 showed a significantly faster mean union time (14.69 weeks) compared to PFN (18.47 weeks). Harris Hip Scores improved significantly in both groups over time, with better results in PFNA2 group. Complications were lower in the PFNA2 group as well. Conclusion: PFNA2 demonstrated superior clinico-radiological outcomes and fewer complications compared to PFN for unstable intertrochanteric fractures, suggesting it may be a better implant choice, particularly in osteoporotic patients.