Comparison Between Proximal Femoral Nailing and Proximal Femoral Locking Plate in Closed Subtrochanteric Fracture

<i>Background:</i> Subtrochanteric femoral fractures are unstable injuries characterized by high mechanical stress, cortical bone predominance and an increased risk of fixation failure. Optimal implant selection remains controversial, particularly for unstable fracture patterns. This study aimed to compare the outcomes of proximal femoral nailing and locking plate fixation in the management of closed subtrochanteric femoral fractures. <i>Methods:</i> This comparative study was conducted at the Department of Orthopaedics, President Abdul Hamid Medical College Hospital, Kishoreganj, Bangladesh, from January to December 2025. Fifty adult patients with closed subtrochanteric femoral fractures were divided into two groups: proximal femoral nailing (PFN, n=25) and proximal femoral locking plate fixation (PFLP, n=25). Intraoperative parameters, postoperative recovery, radiological union, functional outcomes using the Harris Hip Score and complications were evaluated. Statistical analysis was performed using SPSS version 25.0, with significance set at p<0.05. <i>Results:</i> The mean operative time was significantly shorter in the proximal femoral nailing group (85.4 ± 12.5 min) than in the locking plate group (110.6 ± 15.3 min). Intraoperative blood loss was lower with nailing (180 ± 40 mL vs. 270 ± 60 mL). Time to partial weight bearing (4.8 ± 1.2 vs. 6.2 ± 1.6 weeks) and radiological union (17.6 ± 3.1 vs. 20.8 ± 3.7 weeks) were significantly earlier with nailing. Mean Harris Hip Score was higher following nailing (83.5 ± 6.4 vs 77.2 ± 7.8). <i>Conclusion:</i> Proximal femoral nailing provides superior operative efficiency, faster recovery and improved functional outcomes compared with proximal femoral locking plate fixation.