Title : Comparative effectiveness of proximal femoral nail and dynamic hip screw fixation in intertrochanteric femur fractures: A systematic review and meta-analysis
Abstract:
Background: Intertrochanteric femur fractures represent a major burden in the elderly, with over 1.6 million cases annually worldwide. Debate persists regarding optimal fixation between the Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS).
Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines, searching PubMed, Embase, Cochrane, Web of Science, and Scopus from January 2010 to September 2025. Studies directly comparing PFN and DHS in intertrochanteric fractures were eligible. Thirty-three studies met inclusion criteria, comprising randomised controlled trials, prospective, and retrospective cohorts. Analysis was performed using RevMan 5.4.1 with a random-effects model.
Results: PFN demonstrated significantly shorter operative time (MD: −12.30 min, 95% CI: −17.33 to −7.28) and reduced intraoperative blood loss (MD: −115.01 mL, 95% CI: −132.05 to −97.98). Patients achieved full weight-bearing earlier with PFN (MD: −2.21 days, 95% CI: −3.32 to −1.10). PFN was associated with significantly lower total complication rates (RR: 0.46, 95% CI: 0.31–0.68) and reduced infection risk (RR: 0.37, 95% CI: 0.21–0.62). No significant differences were observed in implant failure, Harris Hip Score, or mortality.
Conclusion: PFN offers superior perioperative outcomes and earlier mobilisation compared to DHS, while achieving equivalent long-term functional results and survival. Implant selection should remain individualised, guided by fracture stability, patient comorbidities, and surgeon expertise.
