Introduction: Based on good results obtained with the hip screw and gamma nail and on newer biomechanical studies, we started treating intertrochanteric fractures with other intramedullary devices: the PFN (Proximal Femoral Nail) and Supernail.

Material and methods: From January 2003 to January 2005 we have treated 100 intertrochanteric fractures, 50 with PFN nail and 50 with Supernail. Fracture type distribution and patient’s age were similar in both groups.

Discussion: To evaluate differences in results we have studied various parameters: blood loss, surgical time and healing process.

Results: We haven’t encountered intra-op complications, nor post-op fractures or fixation devices failure. We, although, had two cases of screw cut-out, one for each implant. About 85% of patients reported good-excellent result.

Conclusions: Both nails have brought to reduction of surgical time, blood loss and intra and post-op complications. Best results are achieved following cautious surgical technique: correct nail’s introduction entry, minimal or no proximal reaming, gentle introduction of the nail and particular attention to proximal screw positioning and length.

After previous experience with hip screws and gamma nails, based on recent biomechanical studies, we started treating femoral neck fractures with PFN nail. The proximal femural nail is made of titanium, has two lengths, and a distal flexible component of various diameters with which the femoral neck area can be stabilised with an 11.5-mm cephalic screw and an anti-rotation 6.5-mm screw, both of variable lengths.

From January 2002 to January 2004, 80 of 100 trochanteric fractures were treated with PFN nail. Most fractures were of the 31.A2 and 31.A3 AO type. Mean surgery time was 40 min. Patients began ROM exercises on the first post-operative day and assisted weight-bearing on the fourth and were controlled at 1, 2, and 6 months and then yearly.

No important intra-operative complications and no post-operative fractures have been encountered. However, we do report one case of screw cut-out. About 80% of results were good-excellent.

We can state that the use of PFN nail is of particular value since its unique technical features seem to reduce post-operative complications and surgical stresses, due to less invasiveness, intra-operative complications, and, due to the enhanced stability granted by additional cephalic screws and reduced size and increased flexibility of the distal part of the nail. Finally, we emphasise some surgical tips for best results: respect of correct nail introduction point, minimal proximal reaming, gentle introduction of the nail and particular attention to cephalic screw position and length.