Background: For the management of intertrochanteric fractures, the proximal femoral nail (PFN) has an extra anti-rotational screw (hip pin) to prevent rotation of the cervicocephalic fragments during weight bearing. This study aimed for evaluation of the outcome of proximal femoral nailing for unstable intertrochanteric femur fracture fixation.

Subject and Methods: Thirty-five cases with unstable trochanteric fractures were managed by proximal femoral nails; according to Evans classification thirty were of type Id while five were of type II. After at least 6 to 12 months of follow up, the Harris hip score was used to evaluate the functional outcome of these cases.

Results: The average time of operation was 105 minutes, ranging from 60 minutes to 150 minutes. Two patients experienced local complications; one had a superficial infection that was managed with medicines and the other had a deep infection that necessitated the removal of hardware, debridement, and the insertion of a spacer. The overall rate of local complications was 14.2%. As of the last follow-up, no peri-prosthetic fractures had occurred. With 23 patients, 71.4% were satisfied with the outcome (11 were rated "Excellent," 14 were rated "good," and 10 were rated "not satisfied") (6 fair and 4 poor).

Conclusion: proximal femoral nail is considered the ideal treatment option to fix an unstable intertrochanteric fracture in the ambulatory elderly cases with low perioperative mortality risk.