The aim of the study was to compare mortalitiy and complication rate after operative treatment of pertrochanteric fractures with primary cemented arthroplasty, dynamic hip screw (DHS) or proximal femoral nail (PFN). 283 patients, which were treated betwen 1992 and 2005 for pertrochanteric femoral fractures, except pathologic fractures and a minimum age of sixty years were included. 132 of these 283 patients were treated by primary arthroplasty. Up to the end of 1999 all unstable fractures were treated by primary total hip replacement. In the year 2000 the PFN was introduced and only patients with severe osteoarthritis and osteoporosis received primary arthroplasty. I possible, more stable fractures were treated with a DHS. One year mortality was chosen as main indicator as it depends on the surgical trauma as well as the rapid return to preinjury activity and further complications. A one year period was chosen as the mortality ratio approaches that of an age matched reference population after this interval. Influencing cofactors were eliminated by stepwise logistic regression analysis. It was shown that restoration of the preoperative ambulatory level correlated with survival rate after one year. As elderly patients are often unable to cooperate with partial weight bearing, the primary stability of the device is crucial to allow early mobilisation Mortality was significantly influenced by age, gender and comorbidities but not by fracture classification. One-year mortality was significantly higher for primary total hip replacement (34.2 %) than for internal fixation (DHS: 18.4 %; PFN 21.4 %) and hemiarthroplasty (13.3 %). Since the PFN and hemiarthroplasty were introduced the over all mortality was reduced from 29 % to 18 %.
