Osteoporosis can cause fractures, and inter-rotor fractures are one of the most common and favored sites for osteoporotic fractures. 1, the mechanism of injury of osteoporotic intertrochanteric femur fracture Intertrochanteric fracture can be caused by the action of indirect violence or direct violence. 90% of patients with rotor fracture are low energy two injuries, falls and osteoporosis is the main mechanism of injury. Osteoporosis makes the bones stronger Xiangjiang and more brittle, especially in the hip, where the bone cortex becomes thinner and the bone trabeculae are sparse after the occurrence of osteoporosis, which cannot withstand large pressure and deformation and are prone to fracture. Some scholars believe that osteoporosis is the root cause of inter-rotor fractures and classify inter-rotor fractures in the elderly as facet fractures. The fracture of the lateral femoral cortex was found to be intact in only 5 of the 168 cases (3%). Fung et al. compared the concordance between AO staging and Evans staging and found that AO staging was more concordant. Therefore, the authors suggested that AO typing should be applied to guide the diagnosis and treatment. 3. Treatment philosophy Resetting, fixation, functional exercise and anti-osteoporosis treatment are the basic principles in the treatment of osteoporotic fractures. The treatment of osteoporotic fractures should emphasize individualization and can be non-surgical or surgical. If surgery is performed, it should be done as early as possible. It has been found that delaying surgery beyond 2 d increases the mortality of patients within 30 days and within 1 year. (1) Resetting Fracture resetting is divided into anatomical resetting and functional resetting. Patients with inter-rotor osteoporotic fractures are older, in poor general condition, and prone to loss of repositioning. Therefore, fracture management must be carried out under the conditions allowed by the general condition, and the complication rate must be reduced. If anatomic reduction is pursued, the operation time will be prolonged, which will increase the probability of non-healing incision and infection, and even if anatomic reduction is achieved, it is difficult to achieve complete compression fixation of the fracture end given the nature of osteoporosis. Therefore, indirect repositioning techniques such as traction bed and traction frame should be fully utilized to restore the force line and length, correct rotation and angulation, and adopt relatively stable fixation to maximize the convenience of surgical operation and reduce soft tissue stripping and trauma, with a view to restoring limb function and improving patients’ quality of life without affecting their general condition. (2) Fixation The early movement depends on the stability of internal fixation, which in turn depends on many factors. Compared with extramedullary fixation, intramedullary fixation has a shorter force arm, less torque, better stability, and more obvious biomechanical advantages, especially it can be performed in a minimally invasive way, with less trauma, less blood loss, less need to expose the fracture end, and less damage to the biological environment of fracture healing, which is more conducive to fracture healing. The intramedullary nail is in contact with the fracture end and can be well stabilized even in cases of medial cortical comminution, thus making intramedullary fixation more advantageous for unstable inter-rotor fractures. In recent years, intramedullary fixation is becoming the mainstream of internal fixation, and Anglen et al. found that the percentage of intramedullary fixation increased from 3% to 67% from 1999 to 2006. At present, the new generation of intramedullary fixation products include PFNA, InterTan, etc. The common features of these products are increased resistance to inversion and rotation stability, and simple operation. (3) Application of bone strengthening technology The purpose of using bone strengthening technology is to protect and support the lax bone and reduce and avoid collapse. At present, the clinical use of internal fixation strengthening measures is to strengthen the bone matrix directly with bone cement, that is, after fracture repositioning, choose hollow screw fixation, inject bone cement along the nail tract, and achieve the purpose of filling the osteoporotic bone defects and enhancing the adhesion of internal fixation after curing. In this way, on the one hand, the bone? , the nail interface has an anchoring effect, and on the other hand, the bone cement will spread between the bone trabeculae, expanding the cement-bone contact surface and also strengthening the bone matrix, which can effectively increase the mechanical properties of internal fixation. However, it should be noted that a large amount of bone cement injection can also hinder the healing of the fracture. (4) Artificial hip arthroplasty Artificial hip arthroplasty allows patients to walk early and fully weight-bearing and reduces bedridden complications, so some scholars advocate the use of artificial hip arthroplasty for intertrochanteric fractures of the femur, but some scholars also hold opposing views. When arthroplasty is performed for inter-rotor fractures, it is necessary to reposition the large and small rotors and fix them by ring-tying wires and other J-rows, which is traumatic, bleeding and long, and undoubtedly increases the surgical risk; moreover, because the anatomical landmarks themselves are unclear during surgery, it is difficult to control the placement position of the prosthesis, and the proximal end of the prosthesis often cannot be effectively stabilized; therefore, Liu [et al. suggested that hip replacement for patients with inter-rotor fractures should be performed with Therefore, Liu [et al. (5) Anti-osteoporotic drug treatment in the perioperative period of fracture In addition to surgical treatment of osteoporotic fracture, active anti-osteoporotic drug treatment is particularly emphasized. (1) Basic measures Adhere to a healthy lifestyle, consume a balanced diet rich in vitamin D, calcium, low salt and moderate protein, avoid smoking and alcohol abuse, use drugs that affect bone metabolism with caution, and perform moderate muscle exercise and rehabilitation therapy. ②Recommendations on anti-osteoporosis medication after fracture Patients with osteoporotic fracture should insist on reasonable long-term use of calcium, active vitamin D3, calcitonin, bisphosphonates, sex estrogen receptor modulators, strontium salts and other medications under the guidance of doctors, which can effectively improve improve bone density and enhance the biomechanical properties of bone, thus improving the incidence of osteoporotic fracture and preventing the occurrence of re-fracture. 4, osteoporosis-related complications Osteoporosis can lead to complications such as rapid bone loss and re-fracture after fracture. (1) Rapid bone loss After the application of bone plate and screws for internal fixation, local bone loss can occur under the bone plate due to the local “stress masking” effect and internal and external periosteal vascular injury; coupled with the braking of the affected limb after fracture surgery, it will inevitably lead to increased local bone resorption and decreased bone formation, and the above bone metabolism abnormalities will increase the risk of secondary fracture, so that the affected limb is trapped in A vicious cycle of “fracture – rapid bone loss? fracture” vicious circle. Therefore, interventional treatment for rapid bone loss is necessary. (2) Secondary fractures Secondary fractures can be predicted by a number of factors, and previous studies have shown that age is an important factor that increases the risk for all types of osteoporotic fractures. In conclusion, the treatment of osteoporotic fractures requires not only surgical restoration of normal anatomy and correction of deformity, but also pharmacological treatment to relieve fracture pain and bone loss, promote fracture healing, and enable patients to resume activities as soon as possible, thus reducing the occurrence of complications.