Comparative Analysis of Clinical and Functional Outcomes of Dynamic Hip Screw Versus Proximal Femoral Nail Antirotation (PFNA) in Intertrochanteric Femur Fracture Fixation

Abstract

 Objectives: The comparative clinical and functional effectiveness of dynamic hip screw and proximal femoral nailing for fixation of intertrochanteric femoral fractures in Pakistan.

Study Design and Setting: A hospital-based prospective analytical study was undertaken in a tertiary care hospital of Pakistan, where intertrochanteric fractures constitute a growing burden among older adults and both fixation techniques are routinely employed in resource-constrained clinical environments.

Methodology: In this hospital-based prospective analytical study, 256 patients aged 40–80 years with intertrochanteric fractures were enrolled and allocated to DHS or PFNA groups (n=128 each). Functional outcomes were assessed using the Harris Hip Score (HHS) at six months. Biochemical, clinical, and demographic variables were recorded. Statistical tests included t-test, Mann–Whitney U, chi-square, and logistic regression using SPSS v26, with significance set at p<0.05. Results: PFNA fixation resulted in significantly higher HHS (84.6 ± 7.5 vs. 78.3 ± 8.2: p < 0.001), shorter operative time (65 [58–77] vs. 82 [70–94] min: p < 0.001), and fewer postoperative infections (5.1% vs. 13.9%: p = 0.047) than DHS.

PFNA patients had shorter hospital stays and better pain and ambulation outcomes. Radiological union was more frequent in PFNA but not statistically significant (p = 0.124). Logistic regression identified PFNA as an independent predictor of good functional recovery (OR = 2.78: p = 0.003).

Conclusion: PFNA was associated with superior short-term functional outcomes, reduced surgical morbidity, and fewer complications compared to DHS. These findings support its preferential use in intertrochanteric fracture management within low-resource settings.