الفهرس 
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Abstract
Trochanteric fractures areconsidered of the most common fractures.it usually occurs in the elderly population with considerable medical proplems ninety percent of intertrochanteric fractures in the elderly results from a simple fall .
Displaced fractures are clearly symptom¬atic, on the other hand, some patients with nondisplaced fractures may be ambulatory and experience minimal pain. those with a displaced fracture exhibit the classic shortened exter¬nally rotated extremity.
X-ray of the hip anteroposte¬rior and a cross-table lateral views mostly diagnostic .
Trochanteric fractures are classified into stable and unstable fractures
Despite success of the sliding hip screw in stable fractures, high incidence of many problems as excessive sliding of the lag screw within the plate barrel resulting in limb shortening and medialization of the distal fragment occurred with the unstable fractures .
Intramedullary devices have shorter lever arm which decrease tensile strain on the implant, controlled fracture impaction is maintained.it need less soft tissue dissection than sliding hip screw .
The two cephalic screws fixation devices give a higher mechanical strength than gamma nail since a second locking screw inserted into the femoral neck preventing rotational displacement of the femoral neck.
As the use of the PFN with the size of both cephalic screws (11 and 6.5mm ) requires 17mm reaming . we prefered the use of the nail with two 6.4mm cephalic screws
In our study fourty elderly patients with unstable trochanteric fractures included and all were managed with the short trochanteric antegrade nail . all 40 patients were reviewed for six month follow up except one case escaped from follow up and one died post operative . from those patients 28 were female (70%) and 12 males(30%) and 95% of cases were due to simple fall during walking .
Mean operative time 50 minutes . closed reduction achieved in 92% and was considered anatomical in 75% and accepted in 25% of cases.blood transfusion needed only in 40% of cases .
Patients evaluated according to kyle criteria where 50% have good results ,47% have excellent results and 3% fair results. 70% of patients could start touch weight bearing after the 2nd week after the operation.
Time of union range was between two and five months .
One case developed mechanical failure as slippage of the proximal screws occurred but the patient refused intervention. no deep infection was found but only one case of superficial infection which improved with antibiotics .DVT occurred only in one case post operative and the patient cured with medical treatment.no periprothetic fractures occurred.
SO we consider the short trochanteric antegrade nail as a reliable fixation device which offers the advantages of a closed procedure with a stable biomechanical fixation for the unstable trochanteric fractures. with good functional and anatomical results as well as the low morbidity rate demonstrated throughout our study, we find use of this implant to be of particular interest in primary surgery for elderly patients with unstable trochanteric fractures .