A Randomized Prospective Evaluation of Proximal Femoral Nail versus Proximal Femoral Nail Antirotation 2 for Managing Intertrochanteric Fractures of the Femur

Context: Intertrochanteric fractures are a major cause of morbidity among the elderly. Modern intramedullary devices, such as proximal femoral nail (PFN) and PFN antirotation 2 (PFNA2), aim to provide stable fixation, early mobilization, and reduced complications. Aims: To compare the intraoperative efficiency, functional, and radiological outcomes of PFN and PFNA2 in the fixation of intertrochanteric femur fractures. Settings and Design: Prospective randomized comparative study conducted in the department of orthopedics at our institution between October 2023 and May 2025. Subjects and Methods: Forty patients with intertrochanteric fractures were randomized into two groups: Group A ( n = 20, PFN) and Group B ( n = 20, PFNA2). Functional assessment was performed using the Harris Hip Score, and radiological healing was evaluated using the radiographic union score for hip (RUSH) score. Statistical Analysis Used: Independent sample t -test and Chi-square test were applied; P < 0.05 was considered significant. Results: PFNA2 showed significantly shorter operative time (63.55 ± 12.8 min vs. 85.55 ± 21.9 min, P = 0.0005) and fewer fluoroscopy exposures ( P = 0.0001). Blood loss was lower in PFNA2 but not statistically significant. Functional recovery and radiological union were comparable in both groups, with complete union achieved by 6 months. No implant-related complications were observed. Conclusions: Both PFN and PFNA2 provide excellent union and functional outcomes; however, PFNA2 offers superior surgical efficiency with reduced operative duration and radiation exposure, making it a preferred option for elderly osteoporotic patients.