The Heim´s square is not used to define the proximal segment of the femur. This is an exception. The inferior limit is delimited by a tranverse line below the lesser trochanter.

The constant expansion of the life expectancy of the human being is the cause of the increasing incidence of the fractures of the proximal segment of the femur, directly related to the osteoporosis and, therefore, to the age. The progressive occupancy of the Orthopaedic Surgery hospital beds by elderly people with a fracture of the proximal end of the femur made us recommend, in 1993, the creation of special hospitals.

The frequency of these fractures (42.3% of the total) is the cause of the permanent research into their, generally accepted, surgical treatment. There are two lines of research. One concerns itself with closed surgery, urgent and economical, that accepts approximate reductions and performs internal fixations with nails, even though they may provide only precarious stability. The other, following treatment of the general condition of the patient, aims at anatomical reductions or valgus reductions (applying the ideas of Pauwels) and stable internal fixations by open surgery. The survival results are similar, the immediate economical cost is lower in the first option but the medium term functional results are better in the second option which also gives better economic results in the long term (complications, hospital readmissions, social aspects).

The type A fractures (trochanteric region) are the most frequent and they are at the center of the controversy; this is why we will describe our treatment proposals extensively. For the type B fractures there is a greater consensus and the only discussion relates to the degree of conservatism regarding the cephalic fragment, with the current trend being progressively conservative. The consensus is also greater for the type C fractures, generally subsidiary of prosthetic substitution. When considering joint replacement, there still is controversy between total and partial prosthesis, always because of economical reasons since, under adequate surgical conditions (patient and hospital), the results of the total joint replacement are longer lasting.