Fractures of the femoral shaft in Paget's disease are dangerous and difficult to treat:
1. In twenty-three patients with Paget's disease of the femur, eleven patients were thought to have a satisfactory end result. In three patients the fractures failed to heal and they did not walk again. Five died as a result of osteogenic sarcoma, four of them within the first two months after operation.
2. In fractures of the femoral shaft involved with Paget's disease one should suspect sarcoma and obtain a biopsy specimen.
3. In this series of cases it was not possible to get some of the elderly patients out of bed early, because of inability to achieve rigid internal fixation of the abnormal bone of Paget's disease.
4. Trochanteric fractures healed with the least difficulty.
5. Fractures of the femoral neck in this series did poorly, with one exception. Prosthetic replacement is not advocated.
6. Fractures of the femoral shaft in Paget's disease do not heal faster than fractures in normal bone.
7. No one method of treatment is recommended. Each case must be weighed on its merits after careful preoperative evaluation.