Introduction and purpose: Cases of unstable extracapsular fractures of the proximal femur should be treated by endomedullary nailing; the PFN (Synthes) nail has proved to be a good option for this approach. The purpose of our paper is to make a descriptive study analyzing the medical and technical complications derived from the use of the PFN nail.

Materials and methods: This study reviews a consecutive series of 432 patients implanted with a PFN, out of whom 352 have had a follow-up longer than 6 months. Mean age is 76.3 years and the male/female ratio is 2:1. An analysis was made of the variables related to medical complications inherent in the fracture itself and in the patient characteristics (AO fracture type, ASA surgical risk, organic complications, infection risk factors, duration of hospital stay and mortality) and to secondary mechanical complications caused by implant design or the surgical technique chosen (implant protrusions, system cutting out, osteolysis and intraoperative and postoperative fractures propagated from the tip of the implant).

Results: We performed a frequency analysis and an exponential chi square study which told us that the most frequent fracture was type A2 (AO classification) and the most frequent patient type was ASA III (ASA classification). Mean hospital stay was 6.66 days. During follow-up, medical complications were 17.5% and mechanical ones 11%.

Conclusions: The PFN nail is an efficient means for treating extracapsular fractures of the proximal femur although its use is not free from complications, which could be minimized by employing a careful surgical technique. We found that there is a direct relationship between surgical success and patient ASA type.