Objectives This study aims to compare dynamic hip screw (DHS) with trochanteric stabilizing plate (TSP) versus short proximal femoral nail (PFN) in unstable trochanteric fractures in terms of the functional and radiological outcomes. Patients and methods Between June 2019 and March 2020, a total of 68 patients (32 males, 36 females; mean age: 69.7±8.2 years; range, 60 to 88 years) with unstable trochanteric fractures were included in this randomized-controlled trial. Eligible patients were randomized to undergo DHS with TSP (n=34) or short PFN (n=34) and followed for 12 months. The outcome measures including Harris Hip Score (HHS), operating room time, the amount of blood loss and need for intraoperative transfusion, return to activity, time to union, postoperative complications, failure rate, and mortality rate were analyzed. Results The mean operative time in the DHS+TSP group was 105±10 min, while in the PFN group it was 94±8 min (p=0.001). The mean time until union in the DHS+TSP group was 10.1±1.9 weeks, while in the PFN group, it was 8.8±1.8 weeks (p=0.008). The mean time to return to the pre-fracture activity level in the DHS+TSP group was 12.6±2.6 weeks, while in the PFN group, it was 10.8±2.1 weeks (p=0.005). The mean HHS for the DHS+TPS group was 77.9±8.4, while for the PFN group, it was 80.4±8.7 (p=0.26). There was no significant difference in the walking capability between the two groups. One-year mortality rate was 29.4% in the PFN group and 17.6% in the DHS+TSP group (p=0.284), indicating no significant difference. Mechanical failure was recorded in three cases (8.8%) in the DHS+TSP group compared to two cases (5.8%) in the PFN group with no statistically significant difference. These five cases needed later revisions with total hip replacement. Conclusion The use of PFN in unstable trochanteric fractures was associated with a shorter time until union and a faster return to the pre-fracture level of activity than the DHS+TSP group. Postoperative hip function, walking independence, as well as complication and one-year mortality rates were comparable.

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