[Objective]A comparative analysis of the clinical efficacy of proximal femoral nail anti-rotation (PFNA) or hemi-arthroplasty (HA) in the treatment of unstableintertrochanteric fractures in elderly patients.[Methods] A retrospective study was conducted on 107patients who underwent unstable intertrochanteric fractures from January 2014 to December 2018 in our department.Among them, 61 patients were fixed with PFNA, and 46 patients received HA. A comparison between the two surgical methods (PFNA and HA) included the duration of surgery, intra-operative blood loss, postoperative drainage volume, part and complete weight bearing time of the affected limb,Harris hip scoreand the complications, . [Results]The data were analyzed after 12.50-24.20months (average 18.72±3.49 months) of follow-up. The gender, age of the patients,and the type of fracturedid not differ significantly between the two group; however, the duration of surgery between the PFNA and HA groups did differ, the intra-operative blood lossand postoperative drainage volumein the PFNA group was significantly less than the HA group, andpart or complete weight bearing time of the affected limbwas significantly shorter in the HA group compared with the PFNA group.The difference between the two groups was statistically significant (P <0.05); In terms of Harris score, patients in HA group scored slightly higher at 1 month and 6 months after the operation (P＜0.05), but 1 years laterthere was not statistically significantbetween the two groups. In addition, except for internal plantscomplications(P＜0.05), there were no significant differences in the incidence of other complications such as urinary tract and lung infections(P＞0.05). [Conclusion] PFNA and HA are both safe and effective treatments for unstable intertrochanteric fractures in elderly patients, such patients HAmay be more effective in improving early function and reducing postoperative intraplant-related complications.