Despite the fact that the treatment of hip fractures encompasses a vast amount of medical literature, over the past 50 years, there has been no real improvement with respect to function or even mortality. This has led to the somewhat nihilistic view by most surgeons, community members, and even patients that once an intertrochanteric fracture occurs, there is a progressive decline in both lifestyle and function for the patient. Recently, new methods and concepts are challenging the status quo and may lead to new models on which to base future research and clinical treatment.

In 1951, Ernest Pohl patented the “gliding hip screw,” which consisted of a cannulated screw (first developed by Godoy-Moreira in Brazil in 19381) attached to a lateral femoral plate with a barrel to accommodate the screw. In 1952, Schumpelick et al2 reported on good results with the Pohl device but noted that collapse after surgery resulted in a positive Trendelenberg sign. In 1956, Clawson3 developed the modern sliding hip screw with a strengthened side plate and a blunt tip screw to avoid hip penetration. During this time, Evans4 in his classic paper stressed the importance of obtaining and maintaining an anteromedial reduction of the femoral neck to achieve a better outcome. Sarmiento5 stated that “weight-bearing on the fractured extremity is safe only if the fracture…has been reduced so that there is an accurate fit of the fragments at the anteromedial cortex of the femur.” In 1980, Jensen6 again called attention to the effect of reduction in his classification system and noted that a stable anterior-medial cortex resulted in no secondary displacement, whereas a nonanatomic or unstable fracture resulted in a secondary displacement of 25% to 69% of cases. Despite this trend in recognizing reduction as critical to a good outcome and the importance of rotational stability, in 1963, Holt7 described a nonsliding large bolt-type hip device and specifically expressed the belief that rotational stability was not important in trochanteric fracture fixation. Based on this single study, there was a general trend in thought that rotation was not an important consideration in pertrochanteric hip fractures. This appears to have been the major error negatively affecting our treatment model for hip fractures.