Proximal femoral nail versus dynamic hip screw in treatment of intertrochanteric fractures: a systematic review

Dhruvin Patel; Sahil Kalsariya; Purohit Harsh; Nishant Kakkad; Karan Parekh; Dhrumil Shah; Shemal Shah

doi:10.18203/issn.2455-4510.IntJResOrthop20253294

Authors

Dhruvin Patel Department of Trauma and Orthopaedics, GMERS Medical College Sola, Ahmedabad, Gujarat, India
Sahil Kalsariya Department of Trauma and Orthopaedics, Shalby Hospital, Surat, Gujarat, India
Purohit Harsh Department of Trauma and Orthopaedics, GMERS Medical College Sola, Ahmedabad, Gujarat, India
Nishant Kakkad Department of General Medicine, GMERS Medical College Sola, Ahmedabad, Gujarat, India
Karan Parekh Department of Obstetrics and Gynaecology, GMERS Navsari, Gujarat, India
Dhrumil Shah Department of Trauma and Orthopaedics, GMERS Medical College, Vadnagar, Gujarat, India
Shemal Shah Department of General Surgery, GMERS Navsari, Gujarat, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20253294

Keywords:

Intertrochanteric fracture, Proximal femoral nail, Dynamic hip screw, Internal fixation, Orthopaedic trauma, Functional outcome

Abstract

Intertrochanteric femoral fractures are common in the elderly and typically require internal fixation. This systematic review compared the clinical and radiological outcomes of the proximal femoral nail (PFN) and the dynamic hip screw (DHS) by analyzing 25 studies published between 2000 and 2024 across PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. Key parameters included operative time, intraoperative blood loss, complication and reoperation rates, union time, and functional outcomes measured by the Harris hip score (HHS). Pooled evidence showed that PFN offers significant advantages in unstable fractures (AO/OTA 31-A2 and A3), demonstrating shorter operative time, reduced blood loss, lower implant-failure and reoperation rates, faster radiological union, and higher HHS at 3- and 6-month follow-up compared with DHS. DHS produced comparable results in stable fracture patterns (AO/OTA 31-A1) but was associated with higher mechanical complications in complex cases. Although PFN requires greater technical expertise and carries a small risk of iatrogenic femoral shaft fracture, its intramedullary design provides biomechanical superiority that supports early mobilization and improved functional recovery, especially in elderly osteoporotic patients. Surgical decision-making should therefore consider fracture stability, patient comorbidities, and surgeon experience to optimize outcomes.

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References

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