Surgeon training, experience, and preference are also considerations. For example, younger orthopedic surgeons are more likely to use the nail and interlocking screw system. Older surgeons stick with the sliding compression hip screws.

The patient's health and condition of the bones are two more variables. The presence of osteoporosis can make a difference in which type of fixation method is used. Some types of fixation implants are more likely to cause fracture as a complication. The surgeon does everything possible to avoid this additional problem.

And finally, there's even a difference in how things are done from geographic area to area in the U.S. A review by the American Board of Orthopaedic Surgery showed that newer methods of practice tend to show up first in the southeast, south, and southwest regions. The northwest is often the last place to adopt new practice patterns.

No one is quite sure why surgeons in the South convert to new technologies faster than in the North and Midwest. It may be based on age of patients and/or the age of the surgeon. Research is ongoing to compare different approaches and find out which method works the best regardless of where a patient lives when the procedure is needed.