The increasing number of hip fractures in the elderly constitutes a health care burden. The subset of unstable intertrochanteric hip fractures is important because the treatment of these fractures continues to be hampered by a moderate complication rate. Osteoporosis, fracture geometry, and the success of surgical treatment are strong predictors of outcome. The surgeon is in control of fracture reduction, implant selection, and implant placement, all of which must be optimized to ensure the success of surgical intervention.