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Combined nail screw implants have a technically poor learning curve of up to 8-15% in unstable pertrochanteric fractures. However, early femoral shaft fractures are seen in only 1% of the gamma nails. Most of the technical problems are scraping, collapse (due to bad position or rotational potential). A new implant, PFN, has been developed by AO / ASIF to overcome such problems.

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