Abstract: BACKGROUND: Elderly patients with intertrochanteric fractures often have multiple medical comorbidities and significant osteoporosis, posing considerable challenges for treatment. Proximal femoral nail anti-rotation and InterTAN are both commonly used intramedullary fixation systems. However, there remains insufficient evidence regarding the optimal selection of fixation systems for patients with different medical conditions and fracture types.
OBJECTIVE: To compare the clinical outcomes and complication differences between integrated compression screw and lag screw intertrochanteric nail (InterTAN) and proximal femoral nail anti-rotation in the treatment of elderly patients with intertrochanteric fractures.  
METHODS: A prospective randomized controlled trial was conducted. A total of 118 elderly patients with intertrochanteric fractures who met the inclusion criteria were enrolled. Patients were randomly divided into groups. The proximal femoral nail anti-rotation group (59 cases) underwent internal fixation with proximal femoral nail anti-rotation, and the InterTAN group (59 cases) underwent internal fixation with InterTAN. Perioperative parameters, including operation time, intraoperative blood loss, fluoroscopy frequency, and hospital stay, were recorded. Follow-up assessments were conducted at 1, 3, 6, and 12 months postoperatively. The fracture healing rate, internal fixation stability, and complications were evaluated using Harris hip scores and imaging examinations.  
RESULTS AND CONCLUSION: (1) Operation time, intraoperative blood loss, and fluoroscopy frequency in the proximal femoral nail anti-rotation group were significantly lower than those in the InterTAN group (P < 0.001). No significant difference was found in hospital stay (P > 0.05). (2) The fracture healing rates were similar between the two groups at 12-month follow-up (P > 0.05). At 12 months, the incidence of instability was significantly lower in the InterTAN group (P < 0.05). Harris scores in terms of pain, function, and joint mobility in the InterTAN group were significantly superior to those in the proximal femoral nail anti-rotation group (P < 0.05). There was no significant difference in overall complication rates between the two groups (P > 0.05). (3) These results indicate that proximal femoral nail anti-rotation has certain advantages in reducing perioperative trauma, whereas InterTAN demonstrates greater potential value in terms of fixation stability and functional recovery at the 1-year follow-up. Clinical selection of internal fixation systems should be based comprehensively on the patient's condition and fracture type.

Key words: intertrochanteric fractures, proximal femoral nail anti-rotation, InterTAN, fracture healing, complication