Background: Intertrochanteric femur fractures are common injuries in the elderly population and are frequently associated with osteoporosis. Unstable fracture patterns pose a challenge due to comminution, loss of medial support and high implant failure rates. Intramedullary devices such as Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation 2 (PFNA2) are widely used for stabilization.

Aim: To analyse and compare the functional and radiological outcomes of unstable intertrochanteric femur fractures treated with PFN and PFNA2.

Materials and Methods: This analytical study was conducted at District Hospital Palakkad on patients with unstable intertrochanteric fractures treated using PFN or PFNA2. Patients were followed up clinically and radiologically. Functional outcome was assessed using Harris Hip Score (HHS) and Parker–Palmer Mobility Score (PPMS). Radiological assessment included Tip Apex Distance (TAD) and Cleveland Index. Complications and implant failures were documented.

Results: Both PFN and PFNA2 provided satisfactory fracture union and functional recovery. PFNA2 showed advantages in terms of better rotational stability, reduced implant-related complications, and improved early mobilization. Radiological parameters such as TAD and Cleveland Index were within acceptable limits in both groups.