W HILE metalhc internal fixation for transcervica1 fracture of the femur has been in common use for more than fifteen years, it has only been during the Iast few years that a critica anaIysis of the resuIts has pointed out some of the factors that must be observed to obtain the best resuIts for each individua1 patient. It is generaIIy agreed that earIy contro1 of the patient by the surgeon, anatomic reduction, secure fixation and reguIar and proIonged postoperative supervision are required. Certain of the detaiIed steps of this program are stiI1 under discussion. No Iess than thirty different types of metallic fixation, more than fifty accessory gadgets for measuring, sighting, directing and pIacing the fixation materia1 and hundreds of articIes describing the use of these numerous and ingenious devices are found in the surgical Iiterature. No attempt wiI1 be made to cataIogue this knowIedge, but a safe conclusion to be drawn at this time is that the resuIts can still be improved. EarIy and exact reduction undoubtedly conserves the bIood suppIy which is so important in this fracture. MetaIIic fixation is to be regarded onIy as an efficient and temporary internal spIint to carry the patient over the period unti1 the fracture heaIs. Healing wiI1 be shorter the more efficient and the Iess destructive the type of interna fixation used and the Iess traumatic the technic of pIacing the fixation device. Absorption of the neck is due to excess motion during the heaIing period and since a11 non-viabIe materia1 produces pressure necrosis and Ioosens if sufficient strain is thrown upon it it is desirable to utilize the most efficient immobiIizing devices and to obtain the most stable reductions. It is diffrcuIt to segregate and anaIyze data in the human patient. However, the proof of several points appears now to be beyond question. Compere and WaIIace have furnished experimenta proof that early and accurate reduction Ieads to prompt union with a viable head. The same conclusions are inferred from the statistics of individual surgeons who have reported a high percentage of favorabIe results. The eIimination of shearing stress and its coroIIary, a stable reduction, has been pointed out by those who have given particular attention to the inclination of the fracture line (PauweIs, Eyre-Brook and Priddie and Linton) and by those who have advocated various types of osteotomies. WeIImerIing has pointed out the advantage of utilizing the thick cortical bone a short distance down the Iateral femoral shaft to hoId the internal fixation pin which is driven upward through the neck and head at as oblique an angle as possible. This assumes the use of Ionger fixation materials and their passage through the inferior third of the proximal femoral neck, a region where osseous trabeculae are best deveIoped. McEIveny pointed out that temporariIy increased Iongitudina1 traction accompanied by medial dispIacement of the lower fragment will often secure rotation of the head with a more horizonta1 and stabIe fracture line. It has been the experience of all surgeons that it is impossibIe to determine the time of secure osseous union in transcervial femoral