Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Efficacy of Proximal Femoral Nail Antirotation (PFNA) in Managing Proximal Femoral Fractures: A Systematic Review of Short- and Long-Term Outcomes

Document Type : Systematic Review

Author

Saeed Nouri

Assistant Professor of Orthopaedics, School of Medicine, Ardabil University of Medical Sciences. Ardabil. Iran

10.5281/zenodo.22816007
Abstract
Introduction: Proximal femoral fractures present significant biomechanical fixation challenges, particularly within osteoporotic bone. Although the Proximal Femoral Nail Antirotation (PFNA) provides theoretical rotational and load-sharing advantages via helical blade compaction, clinical evidence regarding sustained performance remains inconsistent. Therefore, this systematic review comprehensively evaluated the short- and long-term clinical, radiological, and functional outcomes of PFNA in proximal femoral fractures.

Material and methods: This systematic review followed PRISMA guidelines and searched PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library without date restrictions. Randomized trials and prospective or retrospective observational studies evaluating PFNA for proximal femoral fractures were eligible. Two reviewers retrospective observational studies evaluating PFNA for proximal femoral fractures were eligible.

Results: Compared with extramedullary fixation, PFNA demonstrated superior union rates, reduced blood loss, and fewer mechanical failures, whereas comparisons with alternative cephalomedullary devices showed comparable clinical, functional, and complication profiles over 12 to8/9). Compared with extramedullary fixation, PFNA demonstrated superior union rates, reduced blood loss, and fewer mechanical failures, whereas comparisons with alternative cephalomedullary devices showed comparable clinical, functional, and complication profiles over 12 to 24 months of follow-up.

Conclusion: The available evidence indicates that PFNA is an effective and safe fixation modality for proximal femoral fractures, offering distinct biomechanical advantages over extramedullary implants and comparable efficacy to other cephalomedullary nails. Although complication rates remain clinically acceptable, high-quality, large-scale randomized trials are still needed to establish definitive superiority regarding long-term functional recovery and implant-specific morbidities across diverse patient cohorts.

Graphical Abstract

Efficacy of Proximal Femoral Nail Antirotation (PFNA) in Managing Proximal Femoral Fractures: A Systematic Review of Short- and Long-Term Outcomes

Keywords

Proximal femoral fractures
Proximal Femoral Nail Antirotation
Cephalomedullary fixation
Systematic review
Subjects
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Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)
Volume 3, Issue 1
January and February 2027
Pages 65-73

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