The charts and roentgenograms of 86 consecutive patients treated by medial displacement osteotomy between 1970 and 1974 were reviewed. All patients had unstable four-fragment intertrochanteric fractures and were treated by the residents and attending staff of the hospitals served by the University of Alabama Medical Center. Thirty patients had sufficient follow-up to be included in the preliminary retrospective study. There were complications of fixation in 11 patients (37%) and one superficial wound infection (3%). The most significant factors associated with complications of fixation were (1) placement of the nail in a superior and anterior position in the femoral neck and head, and (2) advanced osteoporosis. No correlation was noted with the distance of the tip of the nail from the femoral articular cartilage.