Abstract
Objective: To assess indications of using proximal femoral nail anti-rotation (PFNA) nails in fracture related problems.
Methodology: This prospective study was conducted at the Department of Orthopedic Surgery, Dow University of Health Sciences Civil Hospital, Karachi, from January 2017 to December 2019. A total of 31 patients with variable indications were included in the study.
Results: We found that the PFNA useful in difficult femoral fractures. Patients with different indications were operated with PFNA. Three patients with infection underwent surgery in two stages: first with implant removal, reaming, and antibiotic bone cement rod use for six weeks and second with rod removal and PFNA. One patient had an associated ipsilateral segmental tibial fracture with a tibial plateau, one patient had bilateral avascular necrosis, two patients had osteopetrosis, two patients had a broken nail, one patient had a double broken plate, and one patient had a broken locking dynamic condylar screw. All patients were treated with long nails, except two, had short nails. All fractures united in 38–53 weeks, except one. Complications encountered included proximal femoral fractures during reaming in four patients, three required bone graft and one patient had dynamization and superficial infection in the postoperative period each.
Conclusion: We conclude that these fixations displayed increased stability at the proximal end with good capability to hold the neck and prevent rotation, leading to easier entry through the greater trochanter which makes PFNA a good implant for use in difficult proximal femur cases.

Key words: indication, PFNA, subtrochanteric fracture, nonunion.