The authors trace the operative treatment of intertrochanteric hip fractures from the earliest to the most modern methods and describe how current fixation devices evolved. The operative and perioperative morbidity, mortality and outcome in 57 patients treated by Ender's nailing were compared with those of 51 patients treated by Richards' compression-screw fixation. Results were comparable to those found in an extensive review of the literature except for a higher mortality in the group managed by Ender's nailing. The authors conclude that both methods of treatment are acceptable and that the ultimate choice of fixation device should be based on the surgeon's experience tailored to the individual patient's needs.