In general, extramedullary and intramedullary fixation devices are available for the treatment of unstable fractures of the proximal femur. Currently, there is insufficient evidence to say which is best.
Fixation with a cephalomedullary device allows immediate full weight bearing postoperatively. However, it is more difficult than extramedullary fixation and more intraoperative problems may arise. Immediate weight bearing is a must for the elderly. This justifies the preference for intramedullary devices. The Proximal Femoral Nail Antirotation (PFNA) device is a short intramedullary nail which uses a spiral blade device to obtain fixation in the femoral head, rather than a conventional screw. The operative technique
for other cephalomedullary devices is similar, but for details see the manufacturer’s guides.