Objective To investigate the effect of liver insufficiency on the indications, curative effect and perioperative treatment of senile patients with intertrochanteric fractures. Methods A retrospective analysis was performed on 52 elderly patients with intertrochanteric fracture treated by surgery in our hospital from January 2015 to January 2019. According to grade A and B of liver function CHILD, they were divided into group A and Group B (19 and 11 cases respectively), and the perioperative situation, surgical efficacy and imaging changes were compared with control group C (22 cases).Results All patients were followed up for 12 months, and there was no statistically significant difference in perioperative time between the three groups (P > 0.05). Intraoperative blood loss in group B (118.2±37.4) was higher than that in group A (87.89±25.07) and group C (84.1±24.6) (P=0.003).The length of hospital stay in group B (15.27±1.95) was higher than group A (13.47±1.98) and Group C (13.14±2.05) (P=0.018). Follow-up results showed no statistically significant difference between the three groups (P > 0.05), and the time of underground walking in group B (11.27±3.80) was higher than that in group A (8.84±2.12) and group C (8.05±1.70) (P=0.003). Harris score of Group B (78.09±5.47) was lower than group A (84.68±5.77) and Group C (86.23±4.89) (P < 0.001).At the last follow-up, ROM Group (100.91±11.36) was lower than group A (112.11±12.73) and Group C (114.32±12.56) (P=0.016).Comparison of femoral neck dry Angle between the three groups on preoperative, postoperative 3d and at the last follow-up showed no statistically significant difference between the three groups (P > 0.05), and intra-group comparison of the three groups showed statistically significant difference in the results of the three measurements (P < 0.05).Conclusion Elderly patients with intertrochanteric fractures with liver insufficiency should strictly master the indications for surgery, reasonable perioperative treatment and rehabilitation exercise can achieve satisfactory results, but patients with Grade B CHILD still have a high risk of surgery.