Vol. 11, Issue 4 (2025)

Background: Intertrochanteric fractures are common in the elderly, requiring surgical fixation. Intramedullary nails like the Proximal Femoral Nail (PFN) and its second-generation variant, the Proximal Femoral Nail Anti-rotation 2 (PFNA2), are widely used. This study aims to compare the clinical, radiological, and functional outcomes of these two implants.

Methods: A prospective randomized study was conducted on 60 patients with intertrochanteric fractures. Patients were allocated into two groups: Group A (n=30) treated with PFN and Group B (n=30) treated with PFNA2. Parameters assessed included operative time, blood loss, hospital stay, time to mobilization and weight-bearing, Visual Analog Scale (VAS) pain scores, Harris Hip Score (HHS), radiological union, and complications. Follow-up was conducted at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months.

Results: The demographic profiles were comparable. The PFNA2 group showed a statistically significant advantage in operative time (56.8 ± 11.8 vs. 74.5 ± 14.5 mins, p<0.001) and intraoperative blood loss (104.7 ± 19.9 vs. 154.1 ± 18.6 ml, p<0.001). VAS scores were significantly lower in the PFNA2 group at 0 hours post-op (1.0 vs. 1.6, p=0.001). Hospital stay was shorter for PFNA2 (6.8 vs. 8.2 days, p=0.004), and partial weight-bearing was achieved earlier (5.2 vs. 7.2 weeks, p<0.001). HHS was significantly better in the PFNA2 group at 6 weeks (71.4 vs. 67.1, p=0.001), but long-term scores were comparable. Radiological union and complication rates were not significantly different, though the PFN group had more implant-related issues.

Conclusion: Both PFN and PFNA2 are effective for intertrochanteric fractures. However, PFNA2 offers superior perioperative outcomes, including shorter surgery time, less blood loss, reduced hospital stay, earlier partial weight-bearing, and better early functional recovery. The helical blade design of PFNA2 provides a clinical advantage, making it a preferable implant, especially for elderly patients.