Abstract [Objective] To compare the clinical efficacy of closed reduction and limited open reduction with lengthened InterTAN intramedullary nail in the treatment of Seinsheimer V subtrochanteric fractures. [Methods] A retrospective analysis was performed from January 2017 to May 2020 and the case data of Seinsheimer V-type femoral subtrochanteric fractures treated with lengthened InterTAN intramedullary nail internal fixation. A total of 42 cases (43 hips) were used, including closed reduction. There were 15 cases (15 hips) in the closed reduction group, and 27 cases (28 hips) in the limited open reduction group were treated with limited open reduction titanium cables combined with extended InterTAN intramedullary nail fixation. [Results] Both groups of patients were successfully operated without serious complications such as vascular and nerve damage. The operation time and intraoperative blood loss in the limited incision group were significantly more than those in the closed reduction group, and the differences were statistically significant (P<0.05). 42 patients were followed up for 6 to 42 months, with an average of 16.4 months. The imaging examination showed that all patients had good fracture reduction. The fracture healing time of the closed reduction group was significantly longer than that of the limited incision group, and the difference was statistically significant (P<0.05); there was no significant difference in the Harris function score and VAS score of the hip joint at the last follow-up between the two groups (P>0.05) . In the closed reduction group, 1 case had resection due to premature weight-bearing internal fixation and was treated with artificial joint replacement surgery. There was no significant difference in complications between the two groups (P>0.05). [Conclusion] Both closed reduction and limited open reduction and lengthened InterTAN intramedullary nails can achieve better results in the treatment of Seinsheimer V-type femoral subtrochanteric fractures. Limited open reduction has good fracture reduction, reliable fixation, fast healing, and fewer complications. Good choice when closing reset is difficult.