PFN: Definition, Uses, and Clinical Overview

Posted on February 28, 2026 | by drhip

PFN Introduction (What it is)

PFN most commonly refers to a Proximal Femoral Nail.
It is an internal metal implant used to stabilize certain fractures near the top of the thigh bone (femur).
PFN is widely used in orthopedic trauma surgery for hip-region fractures, especially in older adults after a fall.
It is placed inside the femur and secured with screws to help the bone heal in alignment.

Why PFN used (Purpose / benefits)

The main purpose of a PFN is to hold broken bone pieces in a stable position while the body heals the fracture. In fractures around the hip—particularly intertrochanteric and some subtrochanteric femur fractures—bone fragments can shift due to body weight and muscle forces. A PFN aims to reduce this motion and maintain alignment.

In general terms, PFN is used to:

Restore stability to the upper femur so standing and walking can be reintroduced when appropriate.
Maintain fracture alignment (position) to support predictable bone healing.
Provide internal support using a “load-sharing” design (the implant sits within the bone, closer to the body’s weight-bearing axis than many plates).
Help manage fracture patterns that can be difficult to control with non-surgical care alone.

Potential benefits depend on fracture type, bone quality, surgical technique, and rehabilitation planning. Outcomes and recovery expectations vary by clinician and case.

Indications (When orthopedic clinicians use it)

Common situations where clinicians may consider PFN include:

Intertrochanteric femur fractures (fractures between the greater and lesser trochanters)
Unstable trochanteric fracture patterns, where fragments are prone to shifting
Subtrochanteric femur fractures (just below the lesser trochanter), in selected cases
Reverse obliquity or other fracture orientations where sliding fixation may be less effective
Combined patterns involving the trochanteric region and upper shaft of the femur
Certain pathologic fractures (from bone weakness due to disease) when internal fixation is appropriate (selection varies by case)

Contraindications / when it’s NOT ideal

PFN is not the right tool for every hip or femur fracture. Situations where PFN may be less suitable, or where another approach may be preferred, include:

Femoral neck fractures where hip arthroplasty (replacement) or different fixation is more commonly considered (choice depends on displacement, age, bone quality, and other factors)
Severe hip joint disease where replacement surgery may better address both fracture and joint problems (varies by clinician and case)
Active infection near the surgical site or systemic infection that changes surgical timing and strategy
Very small or unusually shaped femoral canal anatomy that may not accept the nail size safely (implant sizing varies by manufacturer)
Certain open fractures or severe soft-tissue compromise, where timing and method of fixation may differ
Patients unable to tolerate anesthesia or surgery due to unstable medical conditions (treated on an individualized risk–benefit basis)
Some periprosthetic fractures (fractures around an existing hip implant), where specialized fixation or revision surgery may be required

In practice, contraindications are often relative rather than absolute, and decisions are tailored to imaging findings, patient health, and surgeon experience.

How it works (Mechanism / physiology)

Biomechanical principle

A PFN is an intramedullary fixation device, meaning it sits inside the femur’s central canal (the medullary cavity). This location gives it a biomechanical advantage: it is positioned closer to the line of body weight through the leg, which can reduce bending forces compared with implants placed on the outside of the bone.

PFN constructs are typically cephalomedullary: they include a nail in the femoral shaft plus one or more large screws (or a blade-style device) that extend into the femoral head and neck. This helps control:

Axial stability (resisting shortening under body weight)
Rotational stability (preventing the head/neck fragment from twisting)
Varus collapse control (limiting inward angulation at the fracture)

Relevant anatomy

Key structures involved include:

Femur (thigh bone): especially the proximal region (head, neck, trochanters)
Femoral head and neck: the “ball” and supporting neck that form the hip joint
Greater and lesser trochanters: bony prominences where major hip muscles attach
Hip abductors and other muscle groups: they can pull fracture fragments out of alignment
Cortical bone and cancellous bone: bone quality affects screw purchase and stability

Onset, duration, reversibility

PFN does not have an “onset” like a medication. Its effect is immediate mechanical stabilization once implanted and properly positioned. The intended duration is typically until fracture healing occurs, but the implant may remain in place long term unless a complication or another reason leads to removal. Implant removal is possible in some circumstances, but it is not automatically required and depends on symptoms, healing, and clinical judgment.

PFN Procedure overview (How it’s applied)

PFN is a surgical implant, not a diagnostic test or medication. The workflow below is a high-level overview; exact steps and choices vary by fracture pattern, implant system, and surgeon preference.

Evaluation / exam – History (such as a fall), pain assessment, and functional status – Physical exam of the hip and leg – Imaging, usually X-rays; CT may be used in selected complex cases – Medical assessment to plan anesthesia and surgical timing
Preparation – Preoperative planning using imaging to estimate implant size and configuration – Positioning to allow fracture alignment (“reduction”) under imaging guidance – Anesthesia selection (commonly regional or general), based on medical factors
Intervention (PFN placement) – Fracture reduction to restore alignment as closely as possible – Creation of an entry point near the top of the femur – Insertion of the nail into the femoral canal – Placement of one or more cephalocervical fixation elements (screw(s) or blade) into the femoral head/neck region – Placement of distal locking screws (often) to control rotation and length, depending on the fracture and implant design
Immediate checks – Intraoperative imaging to confirm alignment and implant position – Final assessment of leg length, rotation, and hardware placement
Follow-up – Postoperative imaging at intervals to assess healing and implant position – Rehabilitation planning (mobility, strengthening, gait training), adjusted to fracture stability and patient factors – Monitoring for complications such as loss of fixation, delayed healing, or implant irritation

Types / variations

“PFN” can refer broadly to a family of proximal femoral intramedullary nails. Variations are chosen based on fracture pattern, patient anatomy, and surgeon preference.

Common PFN variations include:

Short PFN vs long PFN
Short nails generally end higher in the femoral shaft and may be selected for many intertrochanteric fractures.
Long nails extend further down the femur and may be considered for subtrochanteric extension, certain unstable patterns, or to span additional bone at risk. Selection varies by clinician and case.
Single vs dual head fixation
Some PFN systems use one large lag screw into the femoral head.
Others use two screws (a lag screw plus an anti-rotation screw) to help control rotation.
Helical blade designs (PFNA-style constructs)
Some devices use a helical blade instead of a traditional screw. The blade compacts cancellous bone during insertion and may be selected based on bone quality and implant system design. Performance varies by material and manufacturer and by patient factors.
Locking options
Distal locking can be static (more rigid length control) or dynamic (allows controlled compression in some designs). The choice depends on fracture stability goals.
Materials and coatings
Common materials include titanium alloys or stainless steel; specific properties vary by manufacturer (such as stiffness and imaging artifact profiles).

Pros and cons

Pros:

Supports internal stabilization for common hip-region fracture patterns
Intramedullary position can provide favorable load-sharing biomechanics
Can help control rotation and shortening with proximal and distal fixation options
Typically allows smaller incisions than some plating approaches (exact approach varies)
Widely used with standardized instrumentation and established surgical workflows
Can be adapted across different fracture configurations with nail length and locking choices

Cons:

Requires surgery and anesthesia, which carry general medical and procedural risks
Implant positioning is technically sensitive; suboptimal alignment can affect stability
Potential complications include hardware failure, loss of fixation, or malalignment (risk varies by bone quality and fracture type)
Femoral head cutout or migration can occur if fixation in the head is not adequately supported by bone and positioning (risk varies)
Thigh or hip discomfort from hardware prominence can occur in some patients
Follow-up imaging and rehabilitation are typically needed; recovery demands can be significant after a hip fracture

Aftercare & longevity

After PFN fixation, recovery and implant “longevity” are usually discussed in terms of fracture healing and functional recovery, rather than the implant wearing out like a joint replacement.

Factors that commonly influence outcomes include:

Fracture severity and pattern: more complex fractures often require more protection and time
Quality of bone (osteoporosis): can affect how securely screws or blades hold in the femoral head
Quality of reduction (alignment) and implant positioning: important for load distribution
Weight-bearing status: recommendations range from early weight bearing to more restricted plans, depending on stability and clinician judgment
Rehabilitation participation: gait training, strength, and balance work are often part of recovery after hip fracture
Medical comorbidities: nutrition status, diabetes, vascular disease, and other conditions can influence healing capacity
Follow-up schedule and imaging: used to monitor healing and detect hardware issues early

A PFN may remain in place indefinitely if it is not causing problems and the fracture heals in good alignment. Decisions about long-term retention versus removal are individualized and depend on symptoms, healing, and overall risk.

Alternatives / comparisons

PFN is one of several strategies used to manage fractures near the hip. Alternatives depend heavily on fracture type (intertrochanteric vs femoral neck), stability, patient health, and goals of care.

Common comparisons include:

Non-surgical management (observation, pain control, assisted mobility)
Sometimes considered when surgery is too risky or when goals of care prioritize comfort.
For many displaced or unstable hip-region fractures, non-surgical care can lead to prolonged immobility and its complications; decisions are individualized.
Sliding hip screw / dynamic hip screw (DHS)
A plate-and-screw construct on the outside of the femur with a sliding lag screw into the femoral head.
Often considered for stable intertrochanteric fractures; may be less favored for certain unstable patterns where intramedullary devices can offer biomechanical advantages. Choice varies by clinician and case.
Other cephalomedullary nails
“PFN” is sometimes used generically, but multiple nail systems exist (different geometries, screw/blade options, and locking mechanisms).
Selection often depends on fracture pattern, surgeon familiarity, and implant availability.
Arthroplasty (hip replacement)
More commonly used for displaced femoral neck fractures or when joint surfaces are severely compromised.
Replaces the joint rather than fixing the fracture fragments; recovery and risk profiles differ.
Plate fixation (locking plates, proximal femur plates)
May be used in select subtrochanteric fractures, complex patterns, or revision situations.
Can require larger exposures and carries different mechanical considerations than an intramedullary nail.

PFN Common questions (FAQ)

Q: Is PFN the same thing as a hip replacement?
No. PFN typically refers to a fracture fixation implant placed inside the femur to stabilize a broken bone. A hip replacement removes and replaces joint surfaces, which is a different operation used for different indications.

Q: Will I feel the PFN inside my leg?
Some people notice little to no awareness of the implant, while others may feel stiffness or localized discomfort, especially around the upper thigh or screw entry areas. Sensation varies with body habitus, fracture pattern, and how healing progresses.

Q: How painful is PFN surgery and recovery?
Pain is expected after a fracture and after surgery, but the level and duration vary widely. Pain control plans and rehabilitation pacing differ by clinician and by individual medical factors.

Q: How long does a PFN last?
A PFN is designed to provide stability during healing and can often remain in place long term. Whether it is ever removed depends on symptoms, healing, and clinician judgment; routine removal is not universal.

Q: When can someone walk or put weight on the leg after PFN?
Weight-bearing plans range from early weight bearing to partial or restricted weight bearing, depending on fracture stability, bone quality, and intraoperative findings. Your care team’s plan is individualized and may change during follow-up based on imaging.

Q: Is PFN considered safe?
PFN is a commonly used method of fixation for certain proximal femur fractures, but no surgery is risk-free. Potential issues include infection, blood clots, anesthesia risks, malalignment, and hardware-related complications; overall risk depends on patient health and fracture complexity.

Q: What are common complications specific to PFN constructs?
Examples include loss of fixation in the femoral head (such as “cutout” or migration), hardware breakage, irritation from prominent screws, and delayed or non-union in some fracture types. The likelihood varies by case, bone quality, and implant positioning.

Q: Can PFN be used for all hip fractures?
No. PFN is typically used for fractures around the trochanteric region and some subtrochanteric fractures. Femoral neck fractures, periprosthetic fractures, and other patterns may be managed with different fixation devices or arthroplasty.

Q: How much does PFN surgery cost?
Costs vary widely by country, hospital setting, insurance coverage, implant system, and length of stay. Additional costs may include imaging, anesthesia, rehabilitation services, and follow-up care.

Q: When can someone drive or return to work after PFN?
Timing varies with pain control, mobility, reaction time, medication use, and whether the injured side affects driving tasks. Return-to-work timelines depend on job demands (desk-based vs physical work) and functional recovery, and are typically determined case by case.