A Prospective Comparative Study Evaluating Functional and Radiological Outcomes of Intertrochanteric Femur Fractures Treated with Proximal Femoral Nail (PFN) Versus Proximal Femoral Nail Antirotation II (PFNA2) in Adult Patients

Abstract

Background: Intertrochanteric femur fractures are common in elderly populations and are associated with high morbidity and mortality. Intramedullary fixation using proximal femoral nail (PFN) and proximal femoral nail antirotation II (PFNA2) has become the preferred treatmentmodality due to biomechanical advantages and early mobilization. However, the optimal implant remains debated, especially in osteoporoticpatients in resource-limited regions such as Bihar. Aim: To prospectively compare the functional and radiological outcomes of intertrochanteric femur fractures treated with PFN versus PFNA2in adult patients. Methodology: This prospective comparative study was conducted over one year at a tertiary care center in Bihar and included 40 adult patientswith intertrochanteric fractures. Patients were randomly allocated into two groups: PFN (n=20) and PFNA2 (n=20). Intraoperative parameters,fracture union, complications, and functional outcomes using the Harris Hip Score (HHS) were evaluated at 6 weeks, 3 months, 6 months, and12 months. Statistical analysis was performed using SPSS, with p <0.05 considered significant. Results: The PFNA2 group showed significantly shorter operative time and less blood loss compared to PFN (p <0.05). Mean fracture uniontime was earlier in PFNA2 (13.6 weeks) than in PFN (14.8 weeks). At 12 months, mean HHS was higher in PFNA2 (88.9) compared to PFN(84.6) (p <0.05). Implant-related complications were fewer in the PFNA2 group. Conclusion: PFNA2 demonstrates superior operative efficiency, earlier union, and better functional outcomes compared to PFN, making it apreferable implant for intertrochanteric femur fractures, particularly in osteoporotic elderly patients in resource-limited settings.