Abstract: Cephalomedullary fixation has well-recognized indications in reverse obliquity and subtrochanteric femoral fractures, and is now being recommended for use in simple intertrochanteric fractures in osteoporotic patients. There are no published articles examining this subject. We present 271 pertrochanteric fractures managed operatively at the Gold Coast Hospital. A retrospective review was undertaken using DRG codes and ORMIS data specifying "femoral fracture" between January 2002 and December 2004. Nine hundred and fifty charts were identified. All those not identified as having a pertrochanteric fracture were excluded. Other exclusionary grounds were isolated femoral neck fracture and non-operative management. 271 patients were identified as receiving operative management either by a compression hip screw or cephalomedullary fixation. 218 intertrochanteric, 5 basicervical and 48 subtrochanteric fractures were identified. 235 compression hip screws were performed (includes 5 90⁰/95⁰ devices). 35 received cephalomedullary fixation (22 long IMHS, 2 short IMHS, 1 Gamma, 10 recon nails), and one patient received a standard anterograde femoral nail. 233 patients (average age 81) suffered low energy injuries. All reoperations for failure of fixation were in this group. 19 required reoperation, including 7 for failure of fixation. 1.7% (4 of 235) of compression hip screws failed (2 osteoporosis, 1 technical error, 1 inappropriate fixation); 8.3% (2 of 24) IMHS failed (osteoporosis) and the anterograde nail failed (inappropriate fixation). No specific indication for the use of cephalomedullary fixation in simple intertrochanteric fractures was identified. The traditional compression hip screw has a lower revision rate due to osteoporosis.