The rising life expectancy is leading to an increasing incidence of trochanteric fractures, expected to reach over 4.5 million by 2050^(1,2). Geriatric patients with multiple comorbidities, such as diabetes, hypertension, and cardiac issues, are more vulnerable to complications, infections, and mortality⁽³⁾. Hip fractures result in approximately 700,000 deaths worldwide annually, with a one-year mortality rate of 15-30% post-surgery. Surgical intervention with stable fixation devices that enable early mobilization and weight-bearing is often necessary, as many elderly patients struggle to limit weight-bearing during recovery⁽⁴⁾.

The choice of implant for treating trochanteric fractures is still a matter of discussion among medical professionals. One popular option, the dynamic hip screw (DHS), has long been regarded as the standard treatment for stabilizing trochanteric fractures. However, its effectiveness is limited when dealing with unstable and reverse oblique fractures, where it often fails to deliver optimal results^(5,6).

In recent years, intramedullary fixation devices have gained popularity, particularly for treating unstable trochanteric fractures. These devices offer several biomechanical advantages over extramedullary fixation, making them an attractive option for surgeons^(7,8). Among these devices, proximal femoral nails with two proximal screws have been widely used due to their excellent clinical outcomes⁽⁹⁾.

Despite their success, proximal femoral nails with screws are not without complications. Issues such as varus collapse, z-effect, reverse z-effect, implant cut-out, and femoral shaft fractures during and after surgery have been reported⁽¹⁰⁾. To address these concerns, a new design featuring a helical blade has been developed. This design aims to reduce implant-related complications and improve upon the existing screw-based systems⁽¹¹⁾.

The helical blade's unique design allows it to compact the surrounding bone, providing better purchase and increasing resistance to cut-out⁽¹²⁾. As a result, proximal femoral nails with helical blades have gained popularity over the past decade, offering a promising solution for treating trochanteric fractures. Hence, this study compared the functional outcomes of treating intertrochanteric fractures with the Proximal Femoral Nail A2 (PFNA2) using a helical blade versus a compression screw. The goal of treatment was to enable patients to regain their pre-injury functional levels, specifically for those with unstable intertrochanteric hip fractures.