46 patients with a comminuted subtrochanteric femoral fracture were randomized to one of two different fixation groups. One group underwent open reduction and internal plate fixation with a limited exposure technique, "joy-stick" reduction under C-arm imaging, and submuscular plate placement ("biological fixation" group). The other group underwent standard ORIF (direct fixation group). Significant differences observed between groups included a significantly shorter operative time, shorter length of incision, and significantly lower blood loss in the biological fixation group compared to the direct group, but also significantly higher exposure time to fluoroscopy. No significant differences between groups were observed in either fracture healing, complications, or clinical outcome after 11 months.