Published: 2022-04-25

Comparative study to assess the functional outcome in management of inter-trochanteric fractures by proximal femoral nail versus proximal femoral nail anti-rotation

Harpreet Singh, Pranjal Jain, Kamal K. Agarwal, Bineet Oza, Meet Patel, Prashant Makadia


Background: Proximal femoral fractures are one of the most common fractures occurring in elderly due to osteoporosis and increase in life expectancy. The management of these fractures poses a serious challenge in terms of obtaining a stable fixation and a good post-operative outcome. In this study, we compare two intramedullary devices: Proximal femoral nail (PFN) and proximal femoral nail anti-rotation (PFN-A), used commonly for the fixation of proximal femoral fractures.

Methods: Patients presenting with inter-trochanteric fractures were included and randomly allocated to two groups for treatment with either PFN or PFN-A. Pre-operative radiographs of normal side were used to grade osteoporosis by Singh’s index. Post-operative radiographs were used to assess the tip-apex distance and quality of reduction. Functional outcome was compared on the basis of Harris hip score at final follow-up. Patients were followed up at an interval of 1, 3 and 6 months respectively.

Results: The study included 30 patients with 15 patients in each group. The duration of surgery and blood loss was significantly less in PFN-A group as compared to PFN. Functional outcome as assessed by Harris hip score was similar in both the groups. Implant related complications, though less in PFN-A group, had statistically insignificant difference.

Conclusions: It can be safely concluded that, in spite of no differences in functional outcome between the two groups, a shorter duration of surgery and less blood loss would still make PFN-A a better choice in such patients, especially the elderly and co-morbid/compromised patients.


PFN, PFN-A, Harris hip score

Full Text:



De Landevoisin ES, Bertani A, Candoni P, Charpail C, Demortiere E. Proximal femoral nail antirotation (PFN-ATM) fixation of extra-capsular proximal femoral fractures in the elderly: retrospective study in 102 patients. Orthop Traumatol Surg Res. 2012;98(3):288-95.

Li J, Xu XZ, You T, Li H, Jing JH. Early results of the proximal femoral nail antirotation-Asia for intertrochanteric fractures in elderly Chinese patients. Saud Med J. 2014;35(4):385-90.

Babhulkar SS. Management of trochanteric fractures. Indian J Orthop. 2006;40(4):210-18.

Sharma A, Mahajan A, John B. A comparison of the clinico-radiological outcomes with proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA) in fixation of unstable intertrochanteric fractures. Journal of clinical and diagnostic research: JCDR. 2017;11(7):RC05.

Takigami I, Matsumoto K, Ohara A, Yamanaka K, Naganawa T, Ohashi M, Date K, Shmizu K. Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system. Bull NYU Hosp Jt Dis. 2008;66(4):276-9.

Santharam B, Mohammed KF, Ratnam S, Madhav A. A comparative study of intertrochanteric fractures of hip treated with PFN & PFNA 2. IJOS. 2019;5:896-9.

Mittal A, Gill SP, Kumar D, Singh J, Kumar H, Rajput A. Early Functional Outcome of Osteoporotic Intertrochantric Fractures in Elderly Managed with Proximal Femoral Nail and Proximal Femoral Nail Antirotation: A Comparative Study. MAMC J Med Sci. 2021;7(1):63.

Mohan NS, Shivaprakash SU. PFNA v/s PFN in the management of unstable intertrochanteric fractures. J Evol Med Dent Sci. 2015;4(24):4086-92.

Mallya S, Kamath SU, Madegowda A, Krishnamurthy SL, Jain MK, Holla R. Comparison of radiological and functional outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA-2 in patients with osteoporosis. Eur J Orthop Surg Traumatol. 2019;29(5):1035-42.

Kumar CN, Srivastava MP. Screw versus helical proximal femoral nail in the treatment of unstable trochanteric fractures in the elderly. J Clin Orthop Trauma. 2019;10(4):779-84.