Proximal femoral fractures are common in older adults. Zimmer natural nail (ZNN, Cephalomedulary Asia; Zimmer, Warsaw, IN, USA) known as useful in immobilizing the fractures of the proximal femoral fractures, have a critical complications like femoral head perforation and cut through in pelvic bone. We report a case that the femoral head perforation by the hip screw occured within 2 months of the operation, and 8 months after operation, the hip screw is completely separated from the metal body and cut through the pelvis.

Due to the thick cortical structure, subtrochanteric fractures of femur is often caused by high energy trauma and there are only a few report of it from low energy trauma. We have experienced a case of bilateral subtrochanteric fracture which oc-curred after a simple slip down. The fracture was healed with applying intramedullary nail. We believe the fracture may have occurred from prolonged use of steroid which was used to treat underlying rheumatoid arthritis.

This manuscript is reporting the usefulness and treatment results of internal fixation with PHILOS plate in proximal humerus fractures with osteoporosis. Sixteen cases of proximal humerus fractures with osteoporosis were surgically treated with PHILOS plate and followed up for an average 11 months (8-23 months). Mean age was 63 years old (range, 47-88 years old). The functional results were assessed by Neer’s evaluation criteria, Constant evaluation criteria and Korea shoulder scoring system. And the radiological results were assessed by Paavolainen’s method. The mean BMD T- score is -3.5, the mean bone union periods were 15.9 weeks. Functional satisfactory results were thirteen cases in Neer’s evaluation criteria, good results were fourteen cases in Constant evaluation criteria and the mean score is eighty-nine points in Korea shoulder scoring system. Radiologic good results were noted in thirteen cases and fair results were noted in one case. One case showed screw loosening in complication. Internal fixation using PHILOS plate for proximal humerus fractures with osteoporosis makes good functional and radiologic results, so that is considered as a good method.