Comparative Efficacy of PFNA Versus DHS for Intertrochanteric Hip Fractures: An Umbrella Review
Abstract
Introduction: Intertrochanteric hip fractures are common in older patients and pose a major therapeutic challenge. The dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) are the most widely used implants, but the evidence regarding their comparative efficacy remains controversial. Objective: To summarize evidence from systematic reviews and meta-analyses comparing PFNA with DHS for the treatment of intertrochanteric hip fractures. Materials and Methods: An umbrella review of systematic reviews and meta-analyses published between 2013 and 2025 was conducted. Reviews directly comparing PFNA or other proximal femoral nail variants with DHS and reporting at least one relevant clinical or perioperative outcome were included. Because of overlapping primary studies and methodological heterogeneity, a qualitative narrative synthesis was conducted without a new meta-analysis. Results: Ten systematic reviews (nine with meta-analyses) were included, encompassing data from more than 12,000 patients. PFNA showed consistent perioperative advantages, with shorter operative times and less intraoperative blood loss. There were no clinically relevant differences in long-term function or major complications. In unstable fractures, PFNA provided greater biomechanical stability and showed a trend toward less mechanical failure, varus collapse, or shortening. Conclusions: PFNA offers perioperative advantages over DHS, particularly in unstable fractures and in older or high-risk patients. In the long term, both implants yield similar functional outcomes and rates of major complications. Implant selection should therefore be individualized according to fracture pattern, patient condition, surgeon experience, and available resources.Downloads
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