Three important factors guide treatment decisions when following the algorithm outlined in the Vancouver classification system. Anatomic location partitions fractures into one of three categories with Type A occurring around the trochanteric region, Type B near or just distal to the femoral stem, and Type C well below the femoral stem. Type B fractures are subdivided based on stability and bone stock. B1 implies a well-fixed stem, B2 a loose stem with good bone stock, and B3 designates poor surrounding bone stock. Type A greater trochanteric fractures are typically stable and often treated nonoperatively with abduction precautions. Type A lesser trochanter fractures are rare and usually treated nonoperatively unless a large portion of the medial calcar is involved. The loss of the calcar implies instability in which case revision must be considered. Recommended treatment for Type B1 fractures is open reduction and internal fixation with or without cortical strut allograft; for Type B2 fractures revision to a longer femoral component with adjunctive fixation; and for Type B3 fractures revision with a structural allograft, tumor prosthesis, or allograft-prosthetic-composite. Type C fractures are treated with open reduction and internal fixation without regard for the prosthesis [10, 17] (Table 1).