Prospective comparison of PFBN and PFNA in treating elderly unstable intertrochanteric fractures

To compare the clinical efficacy and implant survival between the Proximal Femoral Bionic Nail (PFBN) and the Proximal Femoral Nail Antirotation (PFNA) in elderly patients with unstable intertrochanteric femoral fractures. Patients aged ≥ 65 years with unstable intertrochanteric fractures (AO/OTA 31-A2.2 or higher) admitted between September 2023 and September 2025 were enrolled. One-to-one propensity score matching (PSM) was used to balance baseline characteristics. Perioperative data, Visual Analogue Scale (VAS) pain scores, Harris Hip Score (HHS), complications, and implant survival were analyzed. A total of 173 patients were enrolled. After 1:1 PSM matching, 48 patients were assigned to each group, with balanced baseline characteristics. Repeated measures ANOVA demonstrated significant main effects of time and significant time × group interactions for VAS scores (both P < 0.001). For HHS, only the main effect of time was significant (P < 0.001), whereas the interaction effect was not (P = 0.157). No statistically significant differences were observed between the two groups in operative time, intraoperative blood loss, or length of hospital stay. However, the time to first postoperative ambulation was significantly earlier in the PFBN group compared to the PFNA group (P = 0.022). In the early postoperative phase, the PFBN group exhibited significantly lower VAS scores and higher HHS scores (both P < 0.05). All early between-group differences in VAS and HHS were below predefined MCID thresholds (1.5 points for VAS; 10 points for HHS) and were not clinically significant.Regarding complications, implant failure was stratified into loosening, cut-out, and fracture; the incidence was significantly lower in the PFBN group (4.2% vs. 20.8%, P = 0.027). At the 6-month follow-up, the Harris score remained significantly higher in the PFBN group (P = 0.015). However, at 1 year postoperatively, no statistically significant differences were found between the groups in VAS scores (0.48 ± 0.60 vs. 0.67 ± 0.91, P = 0.133), whereas the PFBN group showed significantly higher HHS (91.67 ± 3.00 vs. 89.35 ± 3.58, t =  - 3.430, P = 0.001). PFBN is associated with earlier ambulation, lower implant failure, and higher implant survival. However, early differences did not reach clinical significance, functional recovery trajectories were similar, and although 1-year HHS was significantly higher in the PFBN group, the difference remained below the MCID and lacked clinical relevance.Trial registration: Chinese Clinical Trial Registry, ChiCTR2400089545. Registered 10 September 2024, https://www.chictr.org.cn/showproj.html?proj=239175.