Short Proximal Femoral Nail using Single Locked Lag Screw versus Dual Lag Screw in Management of Unstable Pertrochanteric Femoral Fractures: A Comparative Study

Background: Unstable pertrochanteric femoral fractures remain a challenging entity, with intramedullary nailing being the preferred treatment. The choice between single versus dual lag screw fixation in short proximal femoral nails remains controversial. Objectives: This study aims to compare clinical and radiological outcomes of unstable pertrochanteric femoral fractures treated with short proximal femoral nails using either a single locked lag screw or dual lag screws with dynamic distal interlocking. Methods: This prospective randomized clinical trial was conducted on 40 patients with AO/OTA 31A2–31A3 fractures. Patients were randomized into two groups: Group 1 (single lag screw, n=20) and Group 2 (dual lag screws, n=20). Functional outcomes were assessed using Harris Hip Score (HHS), while radiological outcomes included union time, time to weight bearing, and complications. Results: Groups were comparable regarding age, sex, comorbidities, and fracture characteristics. Postoperative HHS was significantly higher in Group 2 (81.32 ± 9.48) than in Group 1 (74.37 ± 9.99, p=0.034). Union time was shorter in Group 1 (9.84 ± 2.01 months) compared with Group 2 (11.16 ± 1.77 months, p=0.039). Time to weight bearing was shorter in Group 1 but did not reach statistical significance (7.60 ± 1.88 vs. 8.79 ± 2.37, p=0.09). Complication rates were low and not significantly different between groups. Conclusions: Both fixation techniques are effective and safe. Single lag screw nails may facilitate faster radiological healing, whereas dual lag screws may provide superior functional recovery.