Reduction and Fixation by Proximal Femoral Nail versus Proximal Femoral Nail Antirotation-2 among Patients with Unstable Intertrochanteric Fracture

Abstract Background: The incidence of intertrochanteric (IT) fractures has risen due to increasing osteoporosis and an aging population. Proximal femoral nail (PFN) is a commonly used fixation method, while the PFN Antirotation II (PFNA-2) employs a single helical blade designed to improve rotational control, stability, and compression. Objective: To compare short-term radiological outcomes (reduction quality, fixation stability, and implant positioning) between PFN and PFNA-2 in unstable IT fractures, and to document early postoperative complications. Methodology: Sixty-two patients with unstable IT fractures were allocated to PFN ( n = 31) or PFNA-2 ( n = 31) groups based on the surgeon’s discretion. Reduction quality was assessed using Chang’s criteria and neck–shaft angle; implant positioning was evaluated with tip–apex distance (TAD) and Cleveland index. Radiological follow-up occurred on postoperative day 1, 6 weeks, and 12 weeks. Results: Mean ages were 70.23 ± 12.68 years (PFN) and 73.58 ± 12.86 years (PFNA-2), with most patients being female. Both groups maintained mean neck–shaft angles above 120° and demonstrated acceptable to excellent reductions per Chang’s criteria. The PFN group had a higher mean TAD compared to PFNA-2. Optimal implant placement was achieved in 77.4% of PFN cases and 90.4% of PFNA-2 cases. Conclusion: Both PFN and PFNA-2 provide stable fixation for unstable IT fractures. PFNA-2 showed a trend toward lower TAD, indicating better stability. Precise positioning of the helical blade is essential to prevent cut-out or joint penetration. Larger studies with longer follow-up are needed to confirm these findings.