Proximal Femoral Nailing Versus   Dynamic Hip Screw for Unstable Intertrochanteric Femur Fractures in Adults: A Comparative Prospective Study

Background: The optimal fixation method for unstable intertrochanteric femur fractures remains controversial. Proximal femoral nailing (PFN) and dynamic hip screw (DHS) are the two most widely used techniques. This study compared clinical, radiological, and functional outcomes between PFN and DHS in adults with unstable intertrochanteric fractures. Methods: A prospective randomized study was conducted on 64 adults with unstable intertrochanteric fractures (Tronzo III–V), divided into two groups (PFN = 32, DHS = 32). Outcomes assessed included operative time, intra-operative blood loss, time to radiological union, time to full weight-bearing, Harris Hip Score (HHS) at 6 weeks, 3, 6, and 12 months, and complications such as screw cut-out, varus collapse, limb shortening, infection, reoperation, and femoral shaft fractures. Results: The PFN group demonstrated a significantly shorter mean operative time (58 ± 8 min vs. 79 ± 11 min, p < 0.001) and lower intra-operative blood loss (220 ± 40 mL vs. 360 ± 55 mL, p < 0.001) compared to DHS. PFN patients achieved full weight-bearing earlier (7.5 ± 1.4 weeks vs. 10.2 ± 2.0 weeks, p < 0.001) and showed faster radiological union (12.3 ± 2.1 weeks vs. 15.1 ± 2.8 weeks, p < 0.001). HHS was higher in PFN at 6 weeks (62.1 vs. 55.4, p < 0.01) and 3 months (75.6 vs. 69.2, p < 0.01), with comparable scores at 12 months. Complication rates were lower in PFN, with fewer cases of screw cut-out, varus collapse, and limb shortening. Conclusion: PFN provides better early functional outcomes, reduced operative time and blood loss, and faster mobilization compared to DHS for unstable intertrochanteric femur fractures. Both methods yield comparable long-term functional results, but PFN is preferable for early recovery and lower complication rates.