Comparative Evaluation of TFNA versus PFNA in the Treatment of Intertrochanteric Fractures in Elderly Patients: A Clinical Efficacy Analysis

Background: Intertrochanteric fractures (ITFs) are common in the elderly, often caused by low-energy trauma such as falls. Due to bone fragility and functional limita-tions, surgical fixation is typically required. TFN-ADVANCED™ (TFNA) and proximal femoral nail anti-rotation (PFNA) are two widely used implants for ITF treatment. How-ever, their comparative efficacy remains unclear. Since TFNA replaced PFNA in our institution in October 2022, this study aimed to compare early outcomes and complica-tions of TFNA versus PFNA in elderly ITF patients. Methods: We conducted a retrospective cohort study of 502 patients aged over 60 treated for ITFs between January 2020 and December 2023. Patients were divided into TFNA and PFNA groups. Key parameters analyzed included fracture classification, BMI, ASA score, surgical time, tip-apex distance (TAD), hospital length of stay (LOS), medial wall support (positive: P-MWS vs. negative: N-MWS), and postoperative complications. Statistical significance was set at p < 0.05. Results: A total of 114 patients received TFNA and 298 received PFNA. The mean age was similar (TFNA: 80.9 ± 9.2 years; PFNA: 80.1 ± 8.6 years), with females com-prising 69.2% of the cohort. The fracture types (AO/OTA classification) were compara-ble. The ASA scores and BMIs did not differ significantly. The mean surgical time was nearly identical (TFNA: 74.4 ± 39.3 min; PFNA: 74.5 ± 38.7 min). The TFNA group had a significantly lower mean TAD (15.9 ± 7.1 mm vs. 18.1 ± 6.5 mm, p = 0.004), while LOS was comparable between groups (TFNA: 11.1 ± 8.2 days; PFNA: 10.8 ± 5.9 days). Postoperative complications—including cardiopulmonary, neurological, urinary, gastro-intestinal, wound-related issues, delirium, and transfusion needs—showed no signifi-cant difference between groups. In the TFNA group, 84 patients had P-MWS and 30 had N-MWS; in the PFNA group, 209 had P-MWS and 89 had N-MWS. Internal fixation failure requiring revision surgery occurred more frequently in patients with N-MWS (p = 0.004). Revision was needed in 4 TFNA patients (1 A1, 3 A3 fractures) and 6 PFNA patients (1 A1, 2 A2, 3 A3). In both groups, some patients underwent re-fixation, while others re-quired total or hemiarthroplasty. No third surgeries were reported. All fractures healed postoperatively with satisfactory hip function restoration. Conclusions: Both TFNA and PFNA are effective in treating ITFs in elderly patients, with similar outcomes in surgical time, LOS, fixation failure, and early complications. A lower TAD was noted with TFNA, though its clinical relevance warrants further study. Importantly, P-MWS is associated with greater stability and lower revision rates than N-MWS. Overall, both implants provide reliable fixation and support functional recovery.