Comparison of the efficacy of PFNA and InterTAN intramedullary nail in the treatment of unstable intertrochanteric femoral fractures in the elderly

Abstract

Purpose: To compare clinical outcomes between Proximal Femoral Nail Anti-rotation (PFNA) and InterTAN intramedullary nail system in treating unstable intertrochanteric femoral fractures (IFF) in elderly patients. Methods: A retrospective study of 381 patients with IFF at Tianjin Third Central Hospital compared PFNA (n = 189) and InterTAN (n = 192) surgical treatments. Patient demographics, surgical parameters, postoperative outcomes, Visual Analog Scale (VAS) pain scores, and Harris hip scores were analyzed. Follow-up lasted 6–9 months through outpatient visits and telephone calls. Results: Both groups showed comparable baseline characteristics including age, gender, affected side, injury mechanism, comorbidities, and Tronzo-Evans classification (P > 0.05). The PFNA group demonstrated clinically meaningful shorter operation times and reduced blood loss compared to InterTAN (P < 0.05). The InterTAN group achieved earlier postoperative weight-bearing (P < 0.05). No significant differences were found in hospitalization duration or intraoperative blood transfusion rates (P > 0.05). Pain scores were lower in the InterTAN group during the early postoperative period (P < 0.05). Harris hip scores were superior in the InterTAN group during the first week and month post-surgery (P < 0.05), but showed no significant differences at 3 and 6 months (P > 0.05). Postoperative complication rates were similar between groups (P > 0.05). Conclusion: While both techniques demonstrated comparable long-term outcomes, PFNA may offer advantages in surgical efficiency and blood loss reduction, whereas InterTAN showed improved early postoperative outcomes regarding weight-bearing and initial pain management. The choice between techniques should consider patient-specific factors and surgical priorities. Further prospective studies are warranted to establish stronger clinical guidance.