Abstract
BACKGROUND: Intertrochanteric fractures represent nearly 45% of hip fractures and are rising due to global aging. Surgical fixation, especially intramedullary nailing with PFNA or InterTAN, is the preferred treatment. However, complications like implant failure persist. The proximal femoral bionic nail (PFBN), designed to mimic natural femoral anatomy, has emerged as a promising alternative. This systematic review and meta-analysis aimed to compare PFBN with PFNA or InterTAN. METHODS: This study followed PRISMA guidelines and was registered on PROSPERO. A comprehensive search of PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar was conducted up to June 2025. Studies comparing PFBN with PFNA or InterTAN and reported clinical outcomes were eligible. Two authors independently conducted study selection, data extraction, and risk of bias assessment using ROBINS-I. Also, random-effects meta-analysis, publication bias, sensitivity analysis, and GRADE assessment were conducted. RESULTS: A total of 11 retrospective cohort studies were included. PFBN showed significantly shorter fracture healing and time to weight-bearing compared to both PFNA and InterTAN. The PFBN had a significantly longer surgery duration than the PFNA. No significant differences were found in intraoperative blood loss, hospital stay, Harris Hip Score, or complication rates between PFBN and other devices. Most studies had a low to moderate risk of bias. GRADE assessments mainly indicated moderate to high certainty of evidence. CONCLUSION: This study indicated PFBN as a promising alternative for intertrochanteric fractures, offering faster fracture healing and earlier weight bearing, with similar blood loss, complications, and functional outcomes to PFNA and InterTAN .