Proximal femoral nail: Definition, Uses, and Clinical Overview

Posted on February 28, 2026 | by drhip

Proximal femoral nail Introduction (What it is)

A Proximal femoral nail is an internal metal implant used to stabilize certain fractures near the top of the thigh bone.
It sits inside the hollow center of the femur (the medullary canal) and supports broken bone as it heals.
It is most commonly used for hip-area fractures around the trochanter region, especially after a fall.
It is placed during orthopedic surgery and is checked with imaging during and after the operation.

Why Proximal femoral nail used (Purpose / benefits)

The main purpose of a Proximal femoral nail is surgical repair and stabilization of fractures in the upper femur so that the bone can heal in a controlled alignment.

In everyday terms, fractures near the hip can shift because powerful muscles around the thigh pull the bone fragments in different directions. Without stable fixation, the fracture may heal in a poor position or fail to heal (a problem clinicians may call malunion or nonunion). A Proximal femoral nail is designed to hold the fracture fragments together while allowing the body’s natural bone-healing process to occur.

Orthopedic teams often choose this implant because it is an intramedullary device, meaning it sits along the femur’s internal load-bearing axis. This can provide a “load-sharing” construct: some forces pass through the implant and some through the healing bone. In many fracture patterns, this approach can limit bending forces compared with a plate on the outside of the bone. The implant also allows fixation into the femoral head/neck region (using a large screw or blade) to control rotation and collapse at the fracture site.

Potential benefits, depending on fracture type, bone quality, and surgical goals, may include:

Stable fixation for common hip-region fracture patterns
Support for alignment of the femur during healing
Compatibility with minimally invasive surgical approaches (smaller incisions may be possible)
Options for both short and long implants to match injury location and extent
A construct that can be paired with rehabilitation plans aimed at restoring mobility (timing varies by clinician and case)

Indications (When orthopedic clinicians use it)

A Proximal femoral nail is typically considered for fractures and conditions involving the upper femur, including:

Intertrochanteric (pertrochanteric) femur fractures, particularly unstable patterns
Reverse obliquity intertrochanteric fractures (a specific fracture line orientation)
Subtrochanteric femur fractures (just below the lesser trochanter)
Combined fracture patterns that extend from the trochanteric region into the proximal shaft
Selected pathologic fractures (for example, weakened bone from certain diseases), where intramedullary fixation is appropriate (varies by clinician and case)
Certain revision situations when previous fixation has failed and intramedullary stabilization is being considered (varies by clinician and case)

Contraindications / when it’s NOT ideal

A Proximal femoral nail is not ideal for every hip or femur problem. Situations where another approach may be preferred include:

Fractures primarily inside the hip joint capsule (intracapsular femoral neck fractures), where arthroplasty or other fixation strategies may be used more often (varies by clinician and case)
Severe hip arthritis or pre-existing hip disease where joint replacement is being considered for function rather than fracture fixation (varies by clinician and case)
Active infection near the surgical site or systemic infection concerns, where implanting hardware may not be appropriate until treated
Femoral anatomy that does not accommodate the nail safely (very narrow canal, pronounced bowing, or certain deformities), depending on implant design and surgeon assessment
Poor soft-tissue conditions or open injuries where timing and method of fixation require individualized planning
Certain fracture patterns where a plate-and-screw construct, external fixation, or arthroplasty may better address stability, bone quality, or joint integrity (varies by clinician and case)
Skeletally immature patients (open growth plates), where adult intramedullary implants may be inappropriate (varies by clinician and case)

How it works (Mechanism / physiology)

A Proximal femoral nail works by providing internal mechanical support to a fractured femur while bone heals through normal biological processes.

Biomechanical principle (high level)

The nail is placed inside the femoral canal, which aligns it with the main axis of weight transfer through the thigh.
Proximal fixation (near the hip) is achieved using a large lag screw, dual screws, or a helical blade that passes from the upper femur into the femoral head/neck.
Distal locking screws (farther down the femur) can prevent rotation and control length, depending on fracture type and surgeon preference.
Many designs allow controlled sliding or “dynamization” at the fracture site in some patterns, which can help compression across the fracture as healing progresses (varies by implant design and case).

Relevant anatomy (explained simply)

Femur: the thigh bone, the body’s largest long bone.
Proximal femur: the upper part of the femur near the hip, including the femoral head, femoral neck, greater trochanter, and lesser trochanter.
Medullary canal: the central hollow channel inside the femur where the nail is placed.
Femoral head and neck: important for hip joint motion; fixation into this area helps control the upper fragment of a trochanteric fracture.

Onset, duration, and reversibility

There is no “onset” like a medication. The stabilizing effect begins once the implant is placed and locked during surgery.
The nail is intended to remain stable throughout fracture healing; healing time varies by fracture pattern, bone health, and overall medical status.
The implant can be removed in some cases, but routine removal is not universal and depends on symptoms, healing, and clinician preference (varies by clinician and case).

Proximal femoral nail Procedure overview (How it’s applied)

A Proximal femoral nail is an implant, and its use typically involves a standard orthopedic fixation workflow. The exact steps and instruments vary by surgeon, hospital, and nail system.

1) Evaluation and imaging

Clinical assessment of pain, leg position, mobility, and neurovascular status
Imaging, commonly X-rays; CT may be used in selected cases to define fracture anatomy
Classification of the fracture pattern to guide implant choice and surgical plan

2) Preparation

Pre-operative planning includes selecting nail length/diameter and proximal fixation type (based on anatomy and fracture pattern).
The patient is positioned to allow fracture reduction (alignment) and imaging during surgery.
Anesthesia and perioperative protocols vary by institution and patient factors.

3) Intervention (implant placement)

The fracture is reduced (aligned), often using traction and positioning; reduction may be closed (without opening the fracture) or open in selected cases.
An entry point is made near the top of the femur, and the canal may be prepared to accept the nail (technique varies by implant).
The nail is inserted into the femoral canal.
Proximal fixation is placed into the femoral head/neck region (screw[s] or blade).
Distal locking screw(s) may be added to control rotation and length as needed.

4) Immediate checks

Intraoperative imaging confirms alignment and implant position.
After surgery, additional X-rays may document the final construct and reduction.

5) Follow-up

Follow-up visits commonly include repeat imaging to monitor healing and hardware position.
Rehabilitation and weight-bearing plans are individualized by the treating team and may change as healing progresses.

Types / variations

“Proximal femoral nail” can refer to a family of cephalomedullary nails designed for proximal femur fractures. Common variations include:

Short vs long Proximal femoral nail
Short nails generally extend less far down the femoral shaft and may be used for many intertrochanteric fractures.
Long nails extend farther and may be chosen when the fracture extends into the subtrochanteric/shaft region, when there is concern for additional stress along the femur, or for certain pathologic situations (varies by clinician and case).
Single lag screw vs dual-screw designs
Some systems use one large lag screw into the femoral head.
Others use two proximal screws to improve rotational control in certain patterns (design choice varies by manufacturer and surgeon preference).
Helical blade (blade-style head fixation)
Some nails use a helical blade rather than a traditional screw.
The blade design may be selected for bone purchase characteristics in osteoporotic bone (varies by material and manufacturer).
Locking options (static vs dynamic)
Distal locking can be configured to limit motion (static) or allow controlled settling (dynamic) in selected cases.
Different neck-shaft angles and geometries
Nails are produced with different proximal angles to match patient anatomy and target the femoral head.
Materials and coatings
Common implant materials include titanium alloys or stainless steel; exact properties vary by material and manufacturer.

Pros and cons

Pros:

Provides internal stabilization for many common proximal femur fracture patterns
Intramedullary position aligns with the femur’s weight-bearing axis (load-sharing concept)
Allows fixation into the femoral head/neck to control rotation and collapse
Offers multiple configuration options (short/long nails, different proximal fixation styles)
Often compatible with smaller incisions compared with some plate constructs (varies by case)
Can be used across a range of bone qualities, including osteoporotic bone (implant choice varies)

Cons:

Requires surgery, anesthesia, and intraoperative imaging
Risks include infection, bleeding, blood clots, and anesthesia complications (general surgical risks)
Implant-related issues can occur, such as malposition, screw/blade migration, breakage, or irritation (risk varies by case)
Some fracture patterns may be difficult to reduce or stabilize with a nail and may need another approach
Hardware can be associated with thigh or hip discomfort in some patients, especially with prominent components (varies by anatomy and implant)
Revision surgery may be needed if fixation fails or if healing does not progress as expected (varies by clinician and case)

Aftercare & longevity

Aftercare following placement of a Proximal femoral nail is centered on monitoring fracture healing, maintaining overall health, and progressing function through rehabilitation. Specific instructions (including weight-bearing status) are determined by the surgical team and are based on fracture stability, bone quality, fixation quality, and patient factors.

Common themes that influence outcomes and implant longevity include:

Fracture pattern and stability: Unstable or comminuted fractures (multiple fragments) can require closer monitoring.
Quality of reduction and implant position: Alignment and hardware placement seen on imaging can affect mechanical loading during healing.
Bone health: Osteoporosis and other metabolic bone conditions can influence fixation purchase and healing rate.
Medical comorbidities: Diabetes, vascular disease, smoking status, nutritional status, and certain medications can affect healing potential.
Rehabilitation participation: Physical therapy focuses on safe mobility, strength, balance, and gait mechanics, scaled to the clinical plan.
Weight-bearing progression: Some cases allow earlier loading and others require limitations; timelines vary by clinician and case.
Follow-up imaging: Serial X-rays are commonly used to track callus formation (new bone) and hardware integrity.

In many patients, the implant is designed to be durable enough to remain in place long term. Removal is typically considered only for specific reasons (for example, symptomatic hardware or certain complications) and is not automatically required.

Alternatives / comparisons

A Proximal femoral nail is one of several strategies for managing fractures near the hip. The “best” option depends on fracture location, stability, patient health, and functional goals (varies by clinician and case).

Common alternatives and comparisons include:

Non-operative management (observation, pain control, supportive care)
Considered in selected situations, such as non-ambulatory patients, patients with very high surgical risk, or specific stable fracture patterns.
Trade-offs can include prolonged immobility risks and potentially less predictable fracture alignment.
Sliding hip screw / dynamic hip screw (plate-and-screw fixation)
An extramedullary construct placed on the outside of the femur with a sliding screw into the femoral head.
Often used for certain stable intertrochanteric fractures; may be less favored for some unstable patterns where intramedullary devices are commonly considered (varies by clinician and case).
Fixed-angle plates (including locking plates)
Used for some subtrochanteric fractures or complex patterns, particularly when intramedullary nailing is not feasible due to anatomy or other constraints.
Plates can be effective but may experience different bending forces because they sit outside the bone.
Hip arthroplasty (hemiarthroplasty or total hip replacement)
More commonly considered for displaced intracapsular femoral neck fractures or when joint pathology is a major factor.
Replaces part or all of the hip joint rather than fixing the fracture with a nail.
Other intramedullary nail designs (cephalomedullary nails)
Some systems are not labeled specifically as Proximal femoral nail but function similarly, with design differences in proximal fixation, nail geometry, and locking options.

Proximal femoral nail Common questions (FAQ)

Q: Is a Proximal femoral nail the same as a hip replacement?
No. A Proximal femoral nail stabilizes a fracture so your own bone can heal, while a hip replacement replaces part or all of the hip joint. Both are used around the hip region, but for different problems. Which is used depends largely on fracture location and joint condition (varies by clinician and case).

Q: Will I feel the implant inside my leg?
Some people notice little to no awareness of the implant once healing progresses. Others may feel discomfort related to soft-tissue irritation, especially near the upper thigh where components can be more prominent. Symptoms vary by anatomy, implant design, and healing.

Q: How long does a Proximal femoral nail last?
The implant is designed to be durable and may remain in place indefinitely. Longevity depends on fracture healing, mechanical loading, and whether complications occur. Removal is considered in selected situations and is not routine for every patient (varies by clinician and case).

Q: How painful is recovery after this type of fixation?
Pain levels vary widely based on fracture severity, surgical approach, and individual factors. Pain is often greatest early after injury and surgery, then tends to improve as healing and mobility progress. Care teams typically use multimodal pain strategies and rehabilitation planning, but specifics vary by clinician and case.

Q: When can someone walk or put weight on the leg after surgery?
Weight-bearing status is individualized and depends on fracture stability, bone quality, and fixation characteristics. Some constructs are intended to support earlier mobilization, while others require temporary restrictions. The timeline is set by the treating team and may change as X-rays show healing.

Q: How long is the overall recovery period?
Recovery is usually discussed in phases: early mobility, progressive strengthening, and longer-term return of endurance and balance. Healing timelines differ across intertrochanteric versus subtrochanteric fractures and across patient health profiles. Clinicians track progress with symptoms, function, and follow-up imaging.

Q: What complications can happen with a Proximal femoral nail?
Complications can include infection, blood clots, delayed healing, and anesthesia-related issues, which are general surgical risks. Implant-specific issues can include loss of fixation, hardware migration, malalignment, or breakage, particularly in complex fractures. Overall risk varies by clinician and case.

Q: Can I get an MRI with a Proximal femoral nail?
Many modern orthopedic implants are compatible with MRI under specific conditions, but compatibility depends on the exact implant and MRI settings. Imaging centers typically verify the device details before scanning. Always identification of the implant type and manufacturer is helpful for this process.

Q: Does the implant set off airport metal detectors?
It can. Some detectors may alarm due to implanted metal hardware, while others may not. Responses vary by detector sensitivity and implant size/material.

Q: What does it cost to have a Proximal femoral nail placed?
Costs vary widely by country, hospital setting, insurance coverage, surgeon fees, implant system, and length of hospital stay. Additional costs can include imaging, rehabilitation, medications, and follow-up visits. For any individual case, exact pricing is typically handled through the hospital and payer system.