Comparison of antirotation proximal femoral nail and talon locking nail systems in the treatment of intertrochanteric fractures: functional and cost-effectiveness outcomes

Purpose

This study aimed to compare the clinical outcomes and cost-effectiveness of two widely used intramedullary fixation systems—the Proximal Femoral Nail Antirotation (PFNA) and the Proximal Femoral Nail with Talon Locking System (PFN-TLS)—in the treatment of intertrochanteric femur fractures (ITFF).

Methods

A retrospective cohort study was conducted on 118 patients aged 65–90 years who underwent surgical treatment for ITFF using either PFNA (n = 53) or PFN-TLS (n = 65). All patients were followed for a minimum of 24 months. Preoperative functional evaluation was unavailable; outcomes were assessed at 24 months postoperatively. Surgical parameters, complication and revision rates, functional outcomes (Harris Hip Score [HHS], Visual Analog Scale [VAS], and SF-36), and health-economic indicators (Quality-Adjusted Life Years [QALY], Incremental Cost-Effectiveness Ratio [ICER]) were evaluated. Binary logistic regression analysis was performed to determine independent predictors of favorable functional outcomes.

Results

The PFN-TLS group demonstrated significantly shorter surgical duration, reduced incision length, and lower fluoroscopy exposure (p < 0.05). At the 24-month follow-up, HHS was significantly higher in the PFN-TLS group (82.7 ± 7.4) compared to the PFNA group (76.4 ± 8.1; p = 0.001). VAS and SF-36 scores were also higher, although not statistically significant. Revision rates showed a non-significant trend favoring PFN-TLS. QALY gains were slightly higher in the PFN-TLS group (0.530 vs. 0.449), with a lower cost per QALY ($1,637.93 vs. $1,863.22). PFN-TLS use was independently associated with favorable functional outcomes (OR: 2.62; 95% CI 1.23–5.58; p = 0.013).

Conclusion

Both PFNA and PFN-TLS are effective options for the management of ITFF. However, PFN-TLS may offer additional clinical and economic benefits, including improved functional outcomes and greater cost-efficiency. Findings should be interpreted with caution due to the retrospective design. Prospective, randomized studies are needed to validate these results and guide implant selection in clinical practice.