Comparative Effectiveness of the Proximal Femoral Nail and Dynamic Hip Screw Fixation in Intertrochanteric Femur Fractures: A Systematic Review and Meta-Analysis.

Abstract

This systematic review and meta-analysis compared the clinical effectiveness of proximal femoral nail (PFN) versus dynamic hip screw (DHS) fixation in patients with intertrochanteric femur fractures. A comprehensive literature search was conducted across multiple databases from January 2010 to September 2025, identifying studies that directly compared PFN and DHS fixation outcomes. Thirty-three studies met the inclusion criteria, comprising randomized controlled trials, prospective cohorts, and retrospective comparative studies from diverse geographic regions. The pooled analysis demonstrated several significant advantages favoring PFN fixation. Operative time was significantly shorter with PFN compared to DHS (mean difference (MD): -12.30 minutes, 95% confidence interval (CI): -17.33 to -7.28), while intraoperative blood loss was substantially lower (MD: -115.01 mL, 95% CI: -132.05 to -97.98). Patients treated with PFN achieved full weight-bearing significantly earlier than those receiving DHS. Safety outcomes showed PFN was associated with significantly lower total complication rates (risk ratio (RR): 0.46, 95% CI: 0.31-0.68) and reduced infection risk. However, no significant differences were observed between groups regarding implant failure rates, mortality, or long-term functional outcomes, as measured by the Harris Hip Score. High heterogeneity was noted across most outcomes, reflecting variations in study populations and methodologies. These findings suggest that PFN offers superior perioperative outcomes and early recovery advantages compared to DHS, while maintaining comparable long-term functional results and survival rates in patients with intertrochanteric femur fractures