Femoral fractures in Paget's disease.

Since the original description of osteitis deformans, the treatment of femoral fractures occurring in this disease process has been difficult. A retrospective study of 35 fractures treated over an 8-year period was undertaken to identify the factors that influenced the results. The fractures were classified according to four fracture patterns: subcapital, intertrochanteric, subtrochanteric, and shaft. Chart and radiographic analyses were then performed. The results identified subtrochanteric fractures, occurring in a somewhat younger population, to be the problem fracture. The other three fracture groups did well with standard methods of treatment. Uncemented arthroplasties were not successful; this correlates with the known bone physiology of this age group and this disease process. Blood loss was not statistically significant in any group, although it was greater in the subtrochanteric population. Preoperative assessment by bone scanning and preoperative medical treatment is recommended in the subtrochanteric fracture group.