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In our profession, fractures of the proximal part of the femur are increasing considerably in number, related directly to improved life expectancy [16]. Results of European studies, which are similar to those in the USA, estimate that the number of fractures of the proximal femur will multiply by a factor of two by the year 2050, and the direct costs attributed to osteoporosis will be higher than e 132 000 millions (in 2000, hospital costs directly attributed to osteoporosis were e 4 800 millions, -implying an increase of 33 % in the last 3 years). In 2001, the number of hip fractures in the EU was 480 000, an increase of 25 % over the previous 4 years. For these reasons, the need for suitable treatment of these fractures (and for the prevention of osteoporosis) in order to minimize morbidity/mortality related to all age groups, especially in the elderly, takes on great importance [22].There seems to be a consensus in the current literature and among the various authors that the primary objectives in the treatment of fractures of the proximal femur are to achieve a stable fixation of the fracture so that rapid mobilization of the patient can be initiated and to minimize the risks of implant AbstractHistorically the fractures of the proximal femur have been a challenge for the orthopaedic surgeon, because of the high number of hardware failures and the high mortality rate. The social and medical importance of these fractures is increasing and will be higher in the future because of the improved life expectancy and osteoporosis. The development of new material as well as the design of new devices have improved the results of treatment of this kind of fractures. Historically the plate was the treatment of choice for this kind of fractures, but the high incidence of hardware failures and non-unions led to the introduction of the Gamma nail which initiated a revolution in the concept of treatment of this kind of fractures. The main treatment target is to restore the functional capacity of the patient as soon as possible with the much higher mechanical guarantees of the device in order to obtain the fracture consolidation. A review of the medical literature has been done as well an evaluation of the two main concepts of treatment: plate versus endomedullary nail. Both techniques are not without risks, both have technical complications related to the technique. These complications can be resolved with an adequate learning curve. The experience of the surgeon is important to decrease these technical complications. Although it can lead to controversy about the treatment type for the stable fractures of the EPF, almost all the authors accept the endomedullary g nail (Gamma nail) as the most adequate treatment of the unstable fractures of the proximal femur extremity.

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