Purpose: Evaluating the rate of complications with the use of Proximal femoral nail (P.F.N.), and discuss the reasons for the complications and their solution.

Material and Methods: During last 4.5 years 308 patients underwent P.F.N. for unstable proximal femoral fracture. The average age of the patients was 75.6 (range 20–96).

A.O. classification. A1: 27. A2: 180. A3: 96. In 7 patients a failed dynamic hip screw (D.H.S.) was changed to P.F.N. All the patients were allowed to begin full weight bearing immediately. In 81% of patients short femoral nail was inserted and in the rest long one.

Results:

Complications:Malfixation(internal-rotation, varus, valgus, shorting, bad position of the screw in the neck) – 10%

Deep infection 0.7%, nonuonion 1%, cut out 2%,

Nail breakage 0.6%, Broken drills, bad position of locking screws.

Solutions:

Re-operation 1.6%, T.H.R. 1.3 %, removal of nail 1.6%, nail change 0.9%.

During the last year we began to use a new and improved insertion set with less complications.

Conclusions: P.F.N. is a valid solution for unstable proximal femoral fractures enabling immediate full weight bearing. P.F.N. may be used as a good salvage procedure for failed dynamic hip screw. The procedure demands accurate and meticulous operative technique in order to avoid technical complications. In cutout nails T.H.R. is a good salvage procedure in older patients.