Background: Extracapsular proximal femoral fractures, predominantly seen in elderly osteoporotic patients, pose a significant treatment challenge due to instability and poor bone quality. Proximal Femoral Nail Anti-Rotation (PFNA) is designed to enhance fixation stability and reduce implant-related complications.

Materials and Methods: A prospective clinical study was conducted on 50 patients with extracapsular proximal femoral fractures (AO/OTA 31-A1 to A3) treated with PFNA between January 2020 to December 2020. Patient demographics, operative parameters, radiological union, and functional outcomes (Harris Hip Score) were recorded. Follow-ups were done at 6 weeks, 3 months, and 6 months. Data were analyzed using descriptive statistics.

Results: The mean age of patients was 68.4 years, with 28 males and 22 females. Mean operative time was 65 ± 12 minutes, and mean intraoperative blood loss was 95 ± 20 mL. Radiological union occurred in an average of 13.4 ± 2.1 weeks. At 6 months, 82% of patients achieved good to excellent outcomes. Complications included varus collapse in 4% and superficial infection in 6%, with no implant failure.

Conclusion: PFNA provides stable fixation, allows early mobilization, and yields excellent union rates in extracapsular proximal femoral fractures, making it a preferred implant in elderly osteoporotic patients.