Abstract

Background: Intertrochanteric (IT) fractures account for nearly half of hip fractures, mainly in elderly patients with osteoporosis. Although cephalomedullary nails are widely used for fixation, few studies have directly compared Proximal Femoral Nail Antirotation-II (PFNA-II) and Trochanteric Femoral Nail Advanced (TFNA). In this study, we aimed to compare the functional outcomes and mechanical complication rates of PFNA-II and TFNA, and to assess the impact of TFNA cement augmentation in geriatric patients with osteoporotic IT fractures.

Methods: Between 2019 and 2023, 469 patients were retrospectively classified into three groups: PFNA-II (n = 224), TFNA without cement (n = 104), and TFNA with cement augmentation (n = 141). Perioperative evaluation included AO/OTA classification, reduction quality, Cleveland Index, and tipapex distance. Functional outcomes were evaluated using the Harris Hip Score (HHS), EQ-5D, and Koval score. Mechanical complications were compared between PFNA-II and TFNA groups, and further analyses were performed between the non-cemented and cemented TFNA groups.

Results: No statistically significant differences were observed among the three groups regarding perioperative characteristics. Lateral migration was the predominant complication, with no significant differences in individual complication rates between the two implants. The absence of cut-out in the cemented TFNA group was statistically significant in comparison to the non-cemented group (p = 0.031).

Conclusion: Lateral migration is the most common complication following PFNA-II or TFNA fixation. Although the functional outcomes are comparable, cement augmentation with TFNA is recommended to minimize cut-out risk.