To compare perioperative, radiographic, and functional outcomes between proximal femoral nail antirotation (PFNA) and dynamic condylar screw (DCS) fixation in unstable AO/OTA 31-A2 and 31-A3 pertrochanteric femur fractures. In this retrospective cross-sectional study, 110 adult patients with unstable pertrochanteric fractures treated at a single tertiary trauma center between March 2019 and March 2023 were evaluated. Fifty-five patients underwent PFNA and 55 DCS fixation. Demographic data, comorbidities, fracture classification, operative time, anesthesia duration, intraoperative blood loss, packed red cell transfusion, length of stay, Harris Hip Score (HHS), union status, and complications were recorded. Group comparisons were performed using t tests and chi-square tests with significance set at P<0.05. Baseline age, sex distribution, comorbidities, and AO/OTA fracture type were comparable between groups. PFNA significantly reduced operative time (60.1±10.8 vs 92.3±15.2 minutes), anesthesia duration (82.3±14.7 vs 125.6±25.6 minutes), intraoperative blood loss (759.4±125.3 vs 1025.3±250.3 mL), and transfusion requirements (1.25±0.27 vs 2.85±0.98 units) compared with DCS. Length of stay was slightly shorter with PFNA (4.9±1.3 vs 6.2±1.2 days) but not statistically significant. Excellent or good HHS outcomes were achieved in 78.2% of PFNA and 80.0% of DCS patients. Complete union occurred in 67.3% (PFNA) and 70.9% (DCS), with nonunion rates of 7.3% and 3.6%, respectively. Implant failure and infection were numerically more frequent in the DCS group. PFNA provides superior perioperative efficiency with significantly less operative time, anesthesia duration, blood loss, and transfusion requirements, while maintaining union rates and functional outcomes comparable to DCS. PFNA should be considered the preferred fixation method for unstable pertrochanteric fractures in elderly osteoporotic patients.
Sadighi et al. (Fri,) studied this question.