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The choice between an intramedullary nail and sliding hip screw in proximal femoral fractures has often been driven by surgeon preference and fracture pattern. This prospective randomized multicentre study enrolled 684 patients with intertrochanteric or subtrochanteric fractures and compared the TRIGEN INTERTAN nail with a sliding hip screw. The study assessed pain, mobility, complications and functional recovery over one year. The results did not establish a universal clinical superiority of the nail across all outcomes. Differences in postoperative recovery and implant-related complications were relatively nuanced, reinforcing that fixation should be tailored to the individual fracture rather than based solely on the perceived modernity of the device. For clinicians, the evidence is particularly useful because the sample size was large and the study included a broad elderly fracture population. The practical priorities remain reduction quality, stable fixation, controlled loading and minimising complications. In straightforward stable intertrochanteric fractures, a sliding hip screw remains a defensible option; in more unstable configurations, an intramedullary nail may offer advantages. The implant should follow the biomechanics of the fracture, not the other way around.
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The choice between an intramedullary nail and sliding hip screw in proximal femoral fractures has often been driven by surgeon preference and fracture pattern. This prospective randomized multicentre study enrolled 684 patients with intertrochanteric or subtrochanteric fractures and compared the TRIGEN INTERTAN nail with a sliding hip screw. The study assessed pain, mobility, complications and functional recovery over one year. The results did not establish a universal clinical superiority of the nail across all outcomes. Differences in postoperative recovery and implant-related complications were relatively nuanced, reinforcing that fixation should be tailored to the individual fracture rather than based solely on the perceived modernity of the device. For clinicians, the evidence is particularly useful because the sample size was large and the study included a broad elderly fracture population. The practical priorities remain reduction quality, stable fixation, controlled loading and minimising complications. In straightforward stable intertrochanteric fractures, a sliding hip screw remains a defensible option; in more unstable configurations, an intramedullary nail may offer advantages. The implant should follow the biomechanics of the fracture, not the other way around.
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