A randomized prospective controlled trial of 155 patients with trochanteric fractures compared the AO dynamic hip screw and the Jewett nail plate. The dynamic hip screw showed significantly less evidence of mechanical failure and a lower incidence of reoperation. The implant had no effect on mortality or success of rehabilitation. Mortality was significantly associated with social dependence before fracture and the hospital attended. Capacity to return home and walk again were associated with mobility before fracture and age. While the fate of the majority of patients appeared to be determined by their state before fracture, hospital differences appear to offer the greatest potential for influencing the outcome of this condition.