The treatment of pathologic and impending pathologic fractures of the proximal femur in the elderly.

Forty-eight pathologic and impending pathologic fractures of the proximal femur were surgically treated in 38 patients averaging 70 years of age. The most common tumors were breast (45%), multiple myeloma (24%), and lung (11%). Tumor size, aggressiveness, and location influenced the type of fixation. Sixty-four percent of the lesions were treated by flexible intramedullary nails. This "stress sharing" device afforded sufficient stability to provide pain relief, restore function, and permit healing. Pain was relieved in 92% of the patients, and 84% became ambulatory. The rate of fracture union for patients surviving more than two months was 89%. The average postsurgical survival was nine months. Internal fixation of pathologic and impending pathologic fractures has been recommended in the literature and should not be precluded by advanced age.