Between Jan. 1st 1993 and Dec. 31st 1999 data was collected on 31.917 patients with fractures of the femoral neck in a statewide report card system in Westphalia-Lippe. Only 6.3% of patients were younger than 60 years. Ten percent of the population of Germany live in Westphalia-Lippe so that our data can be considered representative of Germany. A significant change was seen in the following indicators of quality: increase of operative treatment 1993 93.2%--1999 96.0% (p < 0.01 Chi Quadrat Test), decrease of mortality 1993 6.9%--1999 5.7% (p < 0.01 Chi Quadrat Test), decrease of cardiopulmonary complications 1993 11.2%--1999 8.4% (p < 0.01 Chi Quadrat Test), decrease of mean length of stay 1993 33.5 days--1999 22.2 days (p < 0.01 one-way-ANOVA), decrease of pre-operative length of stay 1993 2.57 days--1999 1.86 days (p < 0.01 one-way-ANOVA), increase of operative treatment on weekends (p < 0.01 Chi Quadrat Test). 25% of the patients had post-operative complications. Intra-operative complications were rare (1.4%). Only 48.6% of internal fixations were performed on the day of admission. The most frequent operation is hemiarthroplasty and its frequency is still increasing. Total hip replacement was done 34.1% of all cases. More patients are transferred from primary hospitals to rehabilitation facilities following operative procedures: 1993 8.3%; 1999 27.2%.