MATERIAL AND METHODS In the Department of Traumatology and Reconstructive Surgery of Steglitz Medical Center, Berlin, a total of 1,323 patients with proximal femoral fractures were treated between 1978 and 1992. 988 patients were female and 335 male, age range 18-99 years, mean age 74 years. 479 fractures were classified as medial femoral neck fractures and 205 as lateral femoral neck fractures, further 461 pertrochanteric and 178 subtrochanteric fractures were seen. Based upon computerized data--especially regarding lethality and complication rates--the evolution of fracture treatment is outlined. RESULTS The average lethality of hospitalized patients was 6%, this primarily due to old age and thus especially concerning patients treated with bipolar prosthesis. On the other hand we found a marked methodic dependent peak in lethality, reaching a maximum of 19% in conservatively treated patients. Therefore conservative treatment was exclusively chosen for the limited number of young patients with medial femoral neck fractures showing minimal or no displacement and good impaction. Total infection rate was 0.8%. The rate of local complications was highest with Ender nailing (21.6%). In pertrochanteric fractures this method is therefore no longer utilized and replaced by the DHS. CONCLUSIONS In older patients with medial femoral neck fractures the therapeutic standard today is the bipolar prosthesis, in younger patients osteosynthesis. In lateral femoral neck fractures as well as pertrochanteric fractures the most suitable osteosynthesis is the DHS, in subtrochanteric fractures the condylar plate. Whenever possible osteosynthesis should be preferred to total hip arthroplasty if patient condition and hip joint integrity allow this treatment. The more stable and biological procedure of osteosynthesis should be preferred.