Comparison of clinical and radiological outcomes of a proximal femoral nail with a helical screw versus a proximal femoral nail with two screws in elderly patients with intertrochanteric femur fractures

Abstract

Background: Intertrochanteric femur fractures in the elderly carry high morbidity and mortality rates, while the Proximal Femoral Nail (PFN) is a standard treatment, debate persists regarding the optimal screw configuration. This study compares the clinical and radiological outcomes of the helical blade versus the two-screw PFN in elderly patients with unstable intertrochanteric fractures. Methods: A prospective observational study was conducted on 70 patients aged >60 years with unstable intertrochanteric fractures. Patients were randomized into two groups (n=35 each). Functional outcomes were assessed using the Harris Hip Score (HHS) and radiological union time was evaluated. Operative time and postoperative complications were also recorded. Results: The functional outcomes were comparable between the study groups, most patients demonstrated HHS scores greater than 80, suggestive of favorable functional recovery. A greater proportion of early unions (≤10 weeks) and fewer delayed unions (>16 weeks) were observed in the helical group compared to the 2-screw group. The mean duration of surgery was significantly lower in the helical group (37 minutes) compared to the 2-screw group (45 minutes). Complications  occurred in 10 out of 70 patients, a comparatively better complication profile with the helical blade (3 patients) than 2 screw (7 patients) was observed. Conclusions: Both the helical blade and two-screw are effective. However, the helical blade offers distinct advantages including shorter operative time, faster radiological union, and a lower complication profile, making it a preferable option for early mobilization in elderly patients.