Comparative Evaluation of Outcomes of Intertrochanteric Femur Fractures Treated with Proximal Femur Nail versus Proximal Femur Nail with Trochanteric Support Plate: A Prospective Comparative Study

Background: Intertrochanteric femur fractures are common injuries, particularly in older adults, and are associated with substantial morbidity and functional impairment. Proximal femur nail (PFN) is widely used because of its intramedullary load-sharing characteristics. Unstable fractures with compromised lateral wall integrity may require additional lateral buttressing. Trochanteric support plate (TSP) augmentation has been proposed for this purpose.
Methods: This prospective comparative study was conducted in the Department of Orthopaedics, National Institute of Medical Sciences & Research, Jaipur, over 18 months. Seventy patients with intertrochanteric femur fractures were included, with 35 patients treated with PFN alone and 35 with PFN plus TSP. Functional outcome was assessed using the Harris Hip Score (HHS), and radiological healing using the Radiographic Union Score for Hip (RUSH). Operative time, blood loss, hospital stay, weight-bearing, limb shortening and complications were also recorded.
Results: Mean age was 60.4 ± 14.2 years in the PFN group and 66.8 ± 12.5 years in the PFN + TSP group. Stable fractures constituted 80% of the PFN group, whereas 85.7% of the PFN + TSP group had unstable fractures. Mean operative time was 82 ± 12 versus 112 ± 15 minutes, and mean blood loss was 170 ± 40 versus 290 ± 90 mL. Mean time to partial weight bearing was 8 ± 5 versus 42 ± 2 days. Mean HHS at 6 weeks, 12 weeks and 6 months was 78 ± 8, 92 ± 6 and 98 ± 4 with PFN, compared with 60 ± 10, 75 ± 9 and 88 ± 10 with PFN + TSP. RUSH scores at 6 months were 29 ± 1 and 27 ± 2, respectively. Early and late complications were reported only in the PFN + TSP group in the dissertation dataset.
Conclusion: In this cohort, PFN alone was associated with shorter operative time, lower blood loss, earlier weight bearing, better HHS and higher RUSH scores. PFN + TSP was predominantly used for unstable 31A2 and 31A3 fractures and should be considered selectively when additional lateral wall support is required.

Intertrochanteric femur fracture; proximal femur nail; trochanteric support plate; Harris Hip Score

1. Attum B, Pilson H. Intertrochanteric femur fracture. StatPearls Publishing; 2025. [Google Scholar] [Crossref]

2. Shah MAA, Lü SJ, Zhang JF, et al. Functional morphology of trabecular system in human proximal femur. J Orthop Surg Res. 2025;20:370. [Google Scholar] [Crossref]

3. Mittal R, Banerjee S. Proximal femoral fractures: principles of management and review of literature. J Clin Orthop Trauma. 2012;3(1):15-23. [Google Scholar] [Crossref]

4. Chen PH, Wu CC, Chen WJ. Factors affecting stability of intertrochanteric fractures when elderly patients fall. Biomed J. 2016;39(1):67-71. [Google Scholar] [Crossref]

5. Wichman D, Rasio JP, Looney A, Nho SJ. Physical examination of the hip. Sports Health. 2021;13(2):149-153. [Google Scholar] [Crossref]

6. Park JY, Kim TK, Cho BW, et al. Comparison of mechanical and clinical outcomes between cement-augmented and conventional cephalomedullary nailing in osteoporotic trochanteric fractures. BMC Musculoskelet Disord. 2025;26:1010. [Google Scholar] [Crossref]

7. Zhou X, Jia J, Lian K. Structural characteristics, biomechanics and clinical significance of calcar femorale: a review. Medicine (Baltimore). 2024;103(21):e38323. [Google Scholar] [Crossref]

8. Bartoneček J, Alt J, Naňka O. Internal architecture of the proximal femur: calcar femorale or Adams' arch? Int Orthop. 2023;47(7):1871-1877. [Google Scholar] [Crossref]

9. Aprato A, Lo Baido R, Crosio A, et al. Does lesser trochanter implication affect hip flexion strength in proximal femur fracture? Eur J Trauma Emerg Surg. 2015;41(5):523-529. [Google Scholar] [Crossref]

10. Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femur nail (PFN): a new device for unstable proximal femoral fractures. Injury. 1999;30(5):327-332. [Google Scholar] [Crossref]

11. Bordbar S, Komijani M, Eidy F, et al. The role of lateral wall reconstruction in improving surgical outcomes for intertrochanteric femur fractures. J Exp Orthop. 2025;12(3):e70385. [Google Scholar] [Crossref]

12. Gadegone WM, Shivashankar B, Lokhande V, Salphale Y. Augmentation of proximal femur nail in unstable trochanteric fractures. SICOT J. 2017;3:12. [Google Scholar] [Crossref]

13. Mohebbi S, Amiri A, Nabian MH. Proximal femoral bionic nail offers comparable functional and clinical outcomes to PFNA and InterTAN: systematic review and meta-analysis. J Orthop Surg Res. 2025;20:937. [Google Scholar] [Crossref]

14. Misir A. Current developments in orthopaedic implant technology. J Orthop Surg Res. 2025;20:927. [Google Scholar] [Crossref]

15. Hollensteiner M, Sandriesser S, Bliven E, von Rüden C, Augat P. Biomechanics of osteoporotic fracture fixation. Curr Osteoporos Rep. 2019;17(6):363-374. [Google Scholar] [Crossref]

16. Kani KK, Porrino JA, Mulcahy H, Chew FS. Fragility fractures of the proximal femur: review and update for radiologists. Skeletal Radiol. 2019;48(1):29-45. [Google Scholar] [Crossref]

17. Kaplan K, Miyamoto R, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review. II: intertrochanteric fractures. J Am Acad Orthop Surg. 2008;16(11):665-673. [Google Scholar] [Crossref]

18. Sharma A, Sethi A, Sharma S. Treatment of stable intertrochanteric fractures of the femur with proximal femur nail versus dynamic hip screw: a comparative study. Rev Bras Ortop. 2018;53(4):477-481. [Google Scholar] [Crossref]

19. Karakus O, Ozdemir G, Karaca S, Cetin M, Saygi B. The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly. J Orthop Surg Res. 2018;13:207. [Google Scholar] [Crossref]

20. Krishna CSR, Rao DR. Functional outcome of proximal femur nailing in intertrochanteric fractures. Int J Orthop Sci. 2019;5(2):250-254. [Google Scholar] [Crossref]

21. Carr JB. The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction. J Orthop Trauma. 2007;21(7):485-489. [Google Scholar] [Crossref]

22. Xue D, Yu J, Zheng Q, Li H, Pan Z. Treatment strategies for intertrochanteric fracture nonunion: experience from 23 cases. Injury. 2017;48(3):708-714. [Google Scholar] [Crossref]

23. Kamboj P, Siwach R, Kundu Z, Sangwan S, Walecha P. Results of modified proximal femur nail in peritrochanteric fractures. Internet J Orthop Surg. 2006;6(2):332-337. [Google Scholar] [Crossref]

24. Egol KA, Koval KJ, Zuckerman JD. Handbook of Fractures. 5th ed. Wolters Kluwer; 2014. [Google Scholar] [Crossref]

25. Parker MJ, Handoll HH. Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2010;(9):CD004961. [Google Scholar] [Crossref]

26. Saudan M, Lübbeke A, Sadowski C, et al. Pertrochanteric fractures: is there an advantage to an intramedullary nail? J Orthop Trauma. 2002;16(6):386-393. [Google Scholar] [Crossref]

27. Boldin C, Seibert FJ, Fankhauser F, et al. The proximal femur nail: a minimal invasive treatment of unstable proximal femoral fractures. Acta Orthop Scand. 2003;74(1):53-58. [Google Scholar] [Crossref]

28. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg Am. 1969;51(4):737-755. [Google Scholar] [Crossref]

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