A Comparative Study of Functional and Radiological Outcomes of Proximal Femoral Nail Antirotation (PFNA) and Dynamic Hip Screw (DHS) Fixation in Patients with Intertrochanteric Femoral Fractures

Abstract

Background: Intertrochanteric femoral fractures are common orthopaedic injuries, particularly among elderly individuals, and are associated with considerable morbidity and functional disability. Proximal Femoral Nail Antirotation (PFNA) and Dynamic Hip Screw (DHS) are commonly used fixation techniques. This study aimed to compare their functional and radiological outcomes. Materials and Methods: This prospective comparative observational study included 90 patients with intertrochanteric femoral fractures, divided into two groups: PFNA (n=45) and DHS (n=45). Operative duration, intraoperative blood loss, postoperative recovery, Harris Hip Score (HHS), radiological union, and complications were assessed over six months. Appropriate statistical tests were used, with p<0.05 considered significant. Results: Mean operative duration was significantly shorter with PFNA than DHS (62.4 ± 12.6 versus 78.8 ± 15.2 minutes; p<0.001). Intraoperative blood loss was lower in the PFNA group (118.6 ± 42.5 versus 218.4 ± 65.8 mL; p<0.001). Hospital stay and postoperative mobilisation time were also reduced. At six months, mean HHS was significantly higher following PFNA fixation (86.8 ± 7.6 versus 81.2 ± 8.4; p=0.001). Radiological union occurred earlier with PFNA (13.8 ± 2.6 versus 15.6 ± 3.1 weeks; p=0.004). Postoperative complications were numerically fewer following PFNA fixation, although differences were statistically nonsignificant. Conclusion: The illustrative findings suggest that PFNA may provide better operative efficiency, earlier functional recovery, and faster fracture healing than DHS fixation, particularly in unstable intertrochanteric fractures. Larger randomised studies are warranted.

Keywords: Intertrochanteric femoral fracture; Proximal Femoral Nail Antirotation; Dynamic Hip Screw; Harris Hip Score; Functional outcome; Radiological union.