Introduction: Unstable trochanteric (pertrochanteric and subtrochanteric) femur fractures are associated with high morbidity and mortality due to prolonged immobility. The Proximal Femoral Nail Antirotation-II (PFNA2) was developed to provide improved fixation in such fractures, especially in patients with smaller femoral anatomy. This study evaluates the radiological union, functional outcomes, and complications of long PFNA2 in managing unstable trochanteric femur fractures.

Materials and Methods: Thirty patients with unstable intertrochanteric femur fractures (BoydGriffin types II–IV or AO/OTA 31-A2.2 to A3.3) were treated with long PFNA2 nails in a prospective study at our tertiary hospital. Patients were followed for 12 months. Functional outcome was assessed using the Harris Hip Score (HHS) and SF-12 health survey at 6 weeks, 3 months, 6 months, and 1 year. Radiological union was monitored on serial X-rays. All intra- and postoperative complications were recorded. Descriptive statistics and correlation analyses were performed.

Results: The cohort had a mean age of 65.5 years, and 73% had low-energy mechanism of injury (falls). The predominant fracture patterns were Boyd-Griffin type II (53%) and AO 31-A2.2 (57%). All patients achieved fracture union, with a mean radiological union time of 13.6 weeks (range 8– 20 weeks). By 3 months post-op, 45% of fractures were united; by 4 months, >90% were united. The mean HHS improved from 38 post-operatively to 92 at one year, with 81% of survivors achieving excellent function (HHS ≥90). SF-12 scores similarly improved from 34 to 93. Complications were minimal: one patient (3.3%) had a superficial surgical site infection that resolved with antibiotics, and three patients (10%) showed mild valgus malunion on healing. No implant cut-out, device failure, deep infection, or thromboembolism occurred. Three patients (10%) died of unrelated medical conditions within one year, yielding a 1-year mortality lower than historically reported for hip fractures.