Aims: Subtrochanteric fractures in the elderly are clearly related to osteoporosis. With the new instrumentation early weight bearing in the immediate postoperative treatment offers bigger probability of the one year patientñs survival rate. Methods: We use 2 already well-established nails for diaphyseal and trochanteric fractures coupled together. The new nail enables more stability in osteoporotic diaphysis and lowers the risk of second fracture at the tip of the standard intramedulary hip screw. Results: 54 patients were operated on subtrochanteric fractures with long intramedulary hip screw in the years 1999 Ð 2000. Female to male ratio was 2.6: 1, all were older than 60 years, on average 79.1. All were operated on the second day after admission, average hospital stay was 13.9 days (impact of preoperative morbidity), no intrahospital mortality was noticed in this group. At release 61% of them walked on crutches, 31% were conþned to wheelchair. No deep infections nor delayed union were found. Interlocking screws were removed in 8 patients. The survival rate of those patients who were able to walk independently at time of discharge was signiþcantly higher (p< 0.05) and the inßuence of the longer implant is clearly established. Conclusions: We found out that in elderly people with strong osteoporosis the diaphysis should be buttressed with a long nail like in case of pathologic fractures at proximal and middle third of the femur, with indirect closed reduction. Without exposing the fracture site the osteosynthesis is performed in more biological way. Stability of the long nail positioned in the whole diaphyseal canal enables early weight bearing.