These patients typically present with a short and externally rotated lower extremity. Past medical and social history should be obtained to optimize perioperative management and to prepare for postoperative rehabilitative care. It is important to evaluate the skin (open versus closed fracture) and the neurovascular status. Evaluation of a range of motion is typically not possible due to pain. Many reports include other proximal femoral fractures making analysis difficult. Trochanteric fractures have been considered one group irrespective of the cause or group of patient: These can have a marked influence on outcome. Nonoperative treatment is rarely indicated and should only be considered for non-ambulatory patients and patients with a high risk of perioperative mortality or those pursuing comfort care measures. The outcomes of this method of treatment are poor due to an increased risk of pneumonia, urinary tract infection, decubiti, and deep vein thrombosis. Surgery is the mainstay of treatment for both displaced and nondisplaced intertrochanteric fractures. The primary reason for surgery is to allow the early mobilization of the patient, with partial weight-bearing restrictions depending on the stability of the reduction. The type of surgical treatment is based on the fracture pattern and its inherent stability, as the failure rate is highly correlated with the choice of implant and fracture pattern. Fractures with involvement of the lateral femoral wall are considered an indication for intramedullary nailing and would not be treated with a sliding hip screw. Unstable fracture patterns such as fractures with comminution of the posteromedial cortex, a thin lateral wall, displaced lesser trochanter fractures, subtrochanteric extension of the fracture and reverse obliquity fractures are also indications for intramedullary nailing