Journal of clinical orthopaedics and trauma · 2026
Comparative clinical, radiological and functional outcomes of proximal femoral nail (PFN) versus proximal femoral nail anti-rotation-2 (PFNA-2) in intertrochanteric femur fractures: a systematic review.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Kadambila Vishwas, Arif K S, Sudharshan Abhishek B S, Tameez Ud Din Mohammed, Jacob John Joe
Аннотация
BACKGROUND: Proximal femoral nail (PFN) and proximal femoral nail anti-rotation-2 (PFNA-2) are widely used cephalomedullary devices for fixation of intertrochanteric femur fractures. Despite extensive clinical use, uncertainty remains regarding their comparative mechanical performance.
METHODS: A systematic review was conducted according to PRISMA 2020 guidelines and registered prospectively in PROSPERO (CRD420261283154). MEDLINE, PubMed, Embase, CENTRAL, Scopus and Google Scholar were searched for comparative studies from 1 January 2000 to 31 December 2025. Only English language studies involving human adults were included. Randomized and non-randomized comparative studies reporting outcomes for PFN versus PFNA-2 in intertrochanteric fractures were included. Risk of bias was assessed using Cochrane RoB-2 for randomized trials and the Newcastle-Ottawa Scale for observational studies. Certainty of evidence was evaluated using GRADE.
RESULTS: Ten comparative studies involving 794 patients (PFN = 402; PFNA-2 = 392) were included. Four were randomized or quasi-randomized trials and six were comparative cohort studies. Implant-related mechanical failure was more frequent in PFN. PFNA-2 showed lower rates of screw/blade cut-out, migration, varus collapse, and reoperation. Classical Z-effect and reverse Z-effect phenomena were reported exclusively in dual-screw PFN constructs. PFNA-2 demonstrated a lower absolute risk of implant-related mechanical failure (12.5% vs. 23.4% for PFN), based on aggregated event data. Reoperation rates were also lower with PFNA-2 (8/392) vs PFN (17/402). Operative time and blood loss were generally lower with PFNA-2. Fracture union rates, time to union, and functional scores were comparable between implants.
CONCLUSION: PFNA-2 appears to provide improved mechanical stability with fewer implant-related complications, while fracture healing and functional recovery are similar between PFN and PFNA-2. Implant selection should therefore consider fracture stability, bone quality, surgeon experience, cost, implant availability, and risk of mechanical failure. PFNA-2 may be advantageous in osteoporotic bone and unstable AO/OTA 31-A2 and A3 fracture patterns.
METHODS: A systematic review was conducted according to PRISMA 2020 guidelines and registered prospectively in PROSPERO (CRD420261283154). MEDLINE, PubMed, Embase, CENTRAL, Scopus and Google Scholar were searched for comparative studies from 1 January 2000 to 31 December 2025. Only English language studies involving human adults were included. Randomized and non-randomized comparative studies reporting outcomes for PFN versus PFNA-2 in intertrochanteric fractures were included. Risk of bias was assessed using Cochrane RoB-2 for randomized trials and the Newcastle-Ottawa Scale for observational studies. Certainty of evidence was evaluated using GRADE.
RESULTS: Ten comparative studies involving 794 patients (PFN = 402; PFNA-2 = 392) were included. Four were randomized or quasi-randomized trials and six were comparative cohort studies. Implant-related mechanical failure was more frequent in PFN. PFNA-2 showed lower rates of screw/blade cut-out, migration, varus collapse, and reoperation. Classical Z-effect and reverse Z-effect phenomena were reported exclusively in dual-screw PFN constructs. PFNA-2 demonstrated a lower absolute risk of implant-related mechanical failure (12.5% vs. 23.4% for PFN), based on aggregated event data. Reoperation rates were also lower with PFNA-2 (8/392) vs PFN (17/402). Operative time and blood loss were generally lower with PFNA-2. Fracture union rates, time to union, and functional scores were comparable between implants.
CONCLUSION: PFNA-2 appears to provide improved mechanical stability with fewer implant-related complications, while fracture healing and functional recovery are similar between PFN and PFNA-2. Implant selection should therefore consider fracture stability, bone quality, surgeon experience, cost, implant availability, and risk of mechanical failure. PFNA-2 may be advantageous in osteoporotic bone and unstable AO/OTA 31-A2 and A3 fracture patterns.