METHODS: Forty consecutive female osteoporotic patients with pertrochanteric fractures were selected. The inclusion criteria were: female; age ≥65 years; pertrochanteric fracture resulting from minor trauma. Patients were randomized by a computer-generated list to receive either IMHS fixed with stainless steel lag screws (Group A) or IMHS fixed with HA-coated pins (Group B). RESULTS: Average patient age was 82 ± 8 years in Group A and 78 ± 6 years in Group B. Average BMD was 512 ± 177 in Group A, and 471 ± 231 in Group B. Average intraoperative time was 64 ± 6 minutes in Group A and 34 ± 5 minutes in Group B (p <
0.005). In Group A, all patients had post-operative blood transfusions averaged 2.0 ± 0.1. In Group B, there were no blood transfusions (p <
0.0001). In Group A, the reduction over time in the femoral neck-shaft angle was 6 ± 8, while in Group B, the reduction was 2 ± 1 (p <
0.002). Conclusion: This study showed that intramedullary hip screw with HA-coated lag screw is an effective treatment for unstable fractures in this patient population. The operative time is brief, the fixation is adequate, and the reduction is maintained over time.