Objective To compare the clinical effect of proximal femoral nail antirotation (PFNA) and Inter Tan (an intertrochanteric antegrade proximal femoral nailing system) in the treatment of intertrochanteric fracture in the elderly. Methods The clinical data of 49 elderly patients with intertrochanteric fracture of femur admitted to our department from February 2014 to February 2019 were collected and analyzed retrospectively. According to the treatment, the patients were divided into PFNA group (n=24) and Inter Tan group (n=25). The operation time, bleeding volume, fracture healing time, hospitalization time and complication rate, and Harris score and quality of life (QOL) score after 6 months′ follow-up were compared between the 2 groups. SPSS statistics 13.0 was used for data analysis. Student′s t test or Chi-square test was employed for comparison between the 2 groups. Results No screw loosening or breakage was observed in both groups. The PFNA group had significantly shorter operation time [(43.04±6.25) vs (72.58±6.49)min] and less bleeding volume [(124.5±18.8) vs (238.9±25.6)ml], but obviously higher incidence rates of postoperative complications (16.0% vs 4.2%) when compared with the Inter Tan group (all P<0.05). There were no statistical differences in Harris score [(89.0±2.5) vs (91.5±1.8)] and QOL score [(53.9±3.5) vs (51.2±3.7)] between them at 6 months after operation (P>0.05).Conclusion Both Inter Tan and PFNA have good clinical efficacy in the treatment of intertrochanteric fractures in the elderly. Each of them has its own advantages and disadvantages, and clinical selection should be based on the actual situation of patients.