Aims: To compare the outcome of PFN and DHS þxation of unstable proximal femoral fractures. Methods: The authors conducted a prospective study of 70 consecutive patients with acute AO/ASIF 31-A2 and A3 and complex intertrochantaric fractures. Patients underwent either PFN or DHS fracture þxation depending on surgeon experience and preference. Patients were all followed up for 6months. The main outcome measures were operative blood loss, length of hospital stay, radiographic fracture union, complication rates, independent mobility and residual hip pain at 6 months. Results: The two groups exhibited similar demographic characteristics, premorbid mobility and fracture severity. Operation duration was similar in the two groups although blood loss was signiþcantly less in the PFN group (PFN 275mls; DHS 475mls). There was a signiþcant difference in length of hospital stay (PFN 14 days; DHS 22 days). Three patients in the DHS group suffered failure of þxation, two of them had screw cut out. There were no implant failures or failure of þxation in the PFN group. At 6 months both groups showed similar mobility. Persistent severe hip pain at 6 months was PFN 3% and DHS 9%. Conclusion: The proximal femoral nail may be used successfully in the þxation of unstable femoral fractures with similar results to the DHS for mobility at 6 months. There may be advantages over the DHS in terms of reduced blood loss, shorter hospital stay and less morbidity.