With the cold weather and slippery roads, the elderly are prone to fall when traveling, causing hip pain and inability to walk, resulting in intertrochanteric fractures, which are relatively troublesome to treat and have a high mortality rate of about 10% to 30%. What is intertrochanteric fracture of the femur? An intertrochanteric fracture is a fracture between the base of the femoral neck and the level of the lesser trochanter. It is mostly seen in elderly people over 60 years old, more men than women, about 1,5:1, and belongs to extra-articular capsule fracture. Because of osteoporosis in the elderly, the fracture can occur when the lower limb is suddenly twisted or sharply and excessively abducted or adducted during a fall, or when the external force directly impacts the greater trochanter. The bone is spongy and fragile, and the fracture is mostly comminuted. Misconception 1: There is no need to go to the hospital because of pain. Fracture of the femoral trochanter is a common injury in the elderly, which causes pain in the hip, inability to stand or walk, shortening of the lower limb and external rotation deformity. However, the above-mentioned symptoms are relatively mild in the case of nondisplaced insertion fractures or stable fractures with less displacement. On examination, elevation of the affected trochanter, local swelling and ecchymosis, local pressure pain, and snap on the heel often cause severe pain in the affected area are seen. The diagnosis is often confirmed only after X-ray examination, and the fracture is typed according to the X-ray film. This type of fracture, even if the symptoms are not obvious, should be seen by an orthopedic surgeon in a timely manner and treated with traction or surgery as early as possible. Myth 2: The fracture will heal naturally after a hundred days. The blood supply is rich at the femoral ridge and the contact area of the fracture is large, so the fracture rarely does not heal or the femoral head ischemic necrosis, and the treatment is mainly non-surgical. However, the intertrochanteric fracture is at the root of the thigh, where there are many muscles attached, and it is easy to be displaced. Improper treatment has a tendency to occur hip inversion, forming a deformed joint healing, affecting the function of the affected limb, causing claudication, and may cause traumatic arthritis in the affected limb at a later stage due to the change of the load-bearing line. The method of repositioning by manipulation and local external fixation is bound to fail. If not treated in time, it may cause pneumonia, decubitus ulcer, urinary tract infection, joint contracture, thrombosis and other life-threatening complications due to long-term bed rest after fracture. Myth 3: Surgery must be better than conservative treatment There are certain indications for conservative treatment of intertrochanteric fracture, including patients with intertrochanteric fracture who cannot tolerate anesthesia and surgery (such as patients with recent heart attack), as well as patients who cannot move before the injury and have no obvious discomfort after the injury, patients with sepsis and patients with skin breakdown around the surgical incision. If the patient is unable to walk or has no opportunity to walk again, conservative treatment will be safer, more humane, and less expensive than surgical treatment. Traction can be used to correct shortening, external rotation and hip inversion deformities of the lower extremity and maintain the fracture in an approximate anatomical position and heal. Myth 4: The same fracture surgery method is different The main purpose of surgical treatment of intertrochanteric fracture of the femur is to allow the patient to move early, restore the pre-injury functional status as soon as possible and reduce complications. Femoral intertrochanteric fracture typing (Tronzo-Evans classification): Type I: simple intertrochanteric fracture without displacement. Type II: intact femoral spur with displacement and small coarctation avulsion fracture. Type III: Involvement of femoral spur with displacement and small trochanteric fracture. Type IV: Comminuted fracture of the greater or lesser trochanter. Type V: anticondylar intertrochanteric fracture. There is no unified standard for the selection of surgical method. Different methods should be adopted according to the fracture type, displacement, patient’s age and general condition. Myth 5: Treatment is completely handed over to the doctor on the line most patients believe that as long as the doctor does a good job, the affected limb fully restored to function is not a problem. The stability of internal fixation of a fracture depends on five factors in general: the quality of the bone, the type of fracture, the reduction, the choice of internal fixation, and the position of the internal fixation in relation to the bone. The orthopaedic surgeon can control only the last three factors, but must consider the first two to develop an appropriate treatment plan. There are many clinical cases of postoperative re-fracture, plate fracture, and screw fracture due to various reasons: 1) installation problems: such as poor angulation, poor dressing with the femoral stem, and poor screw selection; 2) plate screw quality problems; 3) premature weight bearing; and 4) non-healing or delayed healing of the fracture, resulting in sustained shear stress and fracture of the plate screw. The first two are related to the surgical operation and the choice of internal fixation, while the last two are related to factors such as the patient’s later functional exercise and personal fitness.