{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T01:53:07Z","timestamp":1755222787555,"version":"3.43.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Intertrochanteric femoral fractures (IFF) are among the most common lower limb fractures in the older population. Our team has developed a new cephalomedullary nail design called the proximal femoral universal nail (PFUN). This study aimed to compare the clinical outcomes of PFUN and proximal femoral nail anti-rotation (PFNA) internal fixation for the treatment of IFF in older patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed the clinical records of 435 older patients with IFF who were treated at Peking University Third Hospital between January 2022 and January 2024. Among them, 215 underwent PFUN (PFUN group) and 220 underwent PFNA (PFNA group) internal fixation. Demographic data, operation time, hospitalization time, blood loss, intraoperative transfusion, complications, Harris hip scores (HHS), and Parker-Palmer mobility scores (PPMS) were compared between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The two groups were comparable in terms of demographic data (<jats:italic>p<\/jats:italic>\u202f&amp;gt;\u202f0.05). The operation time in the PFNA group was shorter than that in the PFUN group, and blood loss was less than that in the PFUN group (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). However, the hospitalization time was shorter in the PFUN group than in the PFNA group (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). At 3 and 6\u202fmonths postoperatively, the HHSs of the PFUN group were significantly higher than those of the PFNA group, and similar results were obtained for PPMS at 6\u202fmonths postoperatively (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). Nevertheless, we found no difference between the groups in the HHSs and PPMSs at 12\u202fmonths postoperatively or at the final follow-up (<jats:italic>p<\/jats:italic>\u202f&amp;gt;\u202f0.05). The rate of fixation failure in the PFUN group was significantly lower than that in the other groups (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05), whereas there was no significant difference in the rate of other general complications (<jats:italic>p<\/jats:italic>\u202f&amp;gt;\u202f0.05). Among patients with AO\/OTA classification 31-A2, the implant failure rate in the PFUN group was significantly lower than that in the other group, and the PPMS score at 6\u202fmonths postoperatively was higher (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). In the AO\/OTA classification of 31-A3 stratification, the Harris score and PPMS score of the PFUN group during the postoperative follow-up period were higher than those of the PFNA group (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The PFUN is an effective and safe internal fixation device for IFFs, especially for unstable medial and lateral wall fractures. Compared to PFNA, PFUN can significantly reduce the rate of implant failure in IFFs and accelerate postoperative rehabilitation. For IFFs with AO\/OTA classifications of 31-A2 and A3, PFUN has a greater advantage than PFNA.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1642909","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T05:24:49Z","timestamp":1754889889000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of proximal femoral universal nail and proximal femoral nail anti-rotation internal fixation for older patients with intertrochanteric femoral fracture: a retrospective cohort 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hip arthroplasty following the failure of intertrochanteric nailing: first implant or salvage surgery?","volume":"14","author":"Solarino","year":"2023","journal-title":"World J Orthop"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.26355\/eurrev_202402_35458","article-title":"Comparison of clinical data between the proximal femoral bionic nail (PFBN) and hip replacement for the treatment of femoral intertrochanteric fracture","volume":"28","author":"Sun","year":"2024","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"229","DOI":"10.7812\/TPP\/19.229","article-title":"Treatment of intertrochanteric femur fractures with long versus short Cephalomedullary nails","volume":"24","author":"Sadeghi","year":"2020","journal-title":"Perm J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.1056\/NEJMcp1611090","article-title":"Management of Acute hip Fracture","volume":"377","author":"Bhandari","year":"2017","journal-title":"N Engl J Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1186\/s13018-020-01943-9","article-title":"Optimal surgical methods to treat intertrochanteric fracture: a Bayesian network meta-analysis based on 36 randomized controlled trials","volume":"15","author":"Cheng","year":"2020","journal-title":"J Orthop Surg Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1007\/s00402-020-03399-2","article-title":"Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation (PFNA II): a study in a southeast Asian population","volume":"141","author":"Zhang","year":"2021","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1016\/j.injury.2020.01.019","article-title":"Medial wall fragment involving large posterior cortex in pertrochanteric femur fractures: a notable preoperative risk factor for implant failure","volume":"51","author":"Li","year":"2020","journal-title":"Injury"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.injury.2017.11.011","article-title":"Risk factors for implant failure after fixation of proximal femoral fractures with fracture of the lateral femoral wall","volume":"49","author":"Gao","year":"2018","journal-title":"Injury"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3397","DOI":"10.1016\/j.injury.2021.07.025","article-title":"Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation","volume":"52","author":"Fan","year":"2021","journal-title":"Injury"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1007\/s00776-015-0770-0","article-title":"Comparison of tip apex distance and cut-out complications between helical blades and lag screws in intertrochanteric fractures among the elderly: a meta-analysis","volume":"20","author":"Li","year":"2015","journal-title":"J Orthop Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1186\/s40001-023-01332-y","article-title":"The PFNA in treatment of intertrochanteric fractures with or without lateral wall fracture in elderly patients: a retrospective cohort study","volume":"28","author":"Tang","year":"2023","journal-title":"Eur J Med Res"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"737","DOI":"10.2106\/00004623-196951040-00012","article-title":"Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation","volume":"51","author":"Harris","year":"1969","journal-title":"J Bone Joint Surg Am"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1302\/0301-620X.75B5.8376443","article-title":"A new mobility score for predicting mortality after hip fracture","volume":"75","author":"Parker","year":"1993","journal-title":"J Bone Joint Surg (Br)"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e59063","DOI":"10.7759\/cureus.59063","article-title":"A comparative study of dynamic hip screws and proximal femoral nails in intertrochanteric fractures","volume":"16","author":"Thusoo","year":"2024","journal-title":"Cureus"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2321","DOI":"10.1038\/s41598-018-20717-2","article-title":"Comparing the intramedullary nail and extramedullary fixation in treatment of unstable intertrochanteric fractures","volume":"8","author":"Zhang","year":"2018","journal-title":"Sci Rep"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1007\/s00264-023-05696-y","article-title":"Proximal femoral bionic nail (PFBN)-an innovative surgical method for unstable femoral intertrochanteric fractures","volume":"47","author":"Zhao","year":"2023","journal-title":"Int Orthop"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1097\/TA.0b013e31829a2c43","article-title":"Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails","volume":"75","author":"Liu","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1007\/s00402-013-1764-z","article-title":"Intramedullary nail versus extramedullary plate fixation for unstable intertrochanteric fractures: decision analysis","volume":"133","author":"Lee","year":"2013","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1186\/s13018-025-05724-0","article-title":"The proximal femoral universal nail system (PFUN): a novel intramedullary nail for treating complex proximal femoral fractures and its biomechanical comparison with the proximal femoral nail anti-rotation (PFNA)","volume":"20","author":"Zhou","year":"2025","journal-title":"J Orthop Surg Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1559765","DOI":"10.3389\/fbioe.2025.1559765","article-title":"A novel nail-plate construct for the treatment of AO\/OTA 31-A3.3 intertrochanteric fractures: a finite element analysis. 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