Abstract: [Objective] To compare the clinical effect of limited open reduction and closed reduction internal fixation with proximal femoral nail anti-rotation（PFNA）for intertrochanteric femoral fractures（IFFs）of AO/OTA type 31-A3. [Methods] The clinical data of 55 cases of fresh and closed IFFs of AO/OTA type 31-A3 under lateral position internal fixation with PFNA through limited open reduction or closed reduction from June 2014 to October 2019 were retrospectively analyzed. According to the reduction methods used, there were 26 cases in the limited open reduction group, and 29 cases in the closed reduction group. The perioperative, follow-up and radiographic documentations were recorded and compared between the two groups. [Results] The hospitalization stay had no significant difference between the two groups（p＞0.05）.As compared to the closed reduction group, the limited open reduction group had longer incision and more intraoperative blood loss，but shorter duration of surgery，less intraoperative fluoroscopy frequency（p＜0.05）.All patients were followed up for at least 12 months. No wound problem happened. As time went after operation, the VAS scores at different time points between the two groups had no statistical difference（p＞0.05）. At the final follow up, 21 cases were rated as excellent，3 as good and 2 as fair in the limited open reduction group, with the excellent and good rate of 92.31%（24/26）; while 15 cases were rated as excellent，11 as good and 3 as fair in the closed group , with the excellent and good rate of 89.66%(26/29) according to the Harris score system, there was no significant difference in the excellent and good rate of Harris score between the two groups （χ2=0.000，p =1.000）. In respect of radiographic assessment, the excellent and good rate of fracture reduction in the limited open reduction group at 3 days after operation was significantly superior to that in the closed reduction group, with statistical difference（χ2=4.044，p =0.044）. At the final follow up, all the fractures healed and no helical blade cut-out. No statistical significances were found in bone healing time, femoral neck-saft angle（NSA）and tip-apex distance（TAD）between the two groups（p＞0.05）.1 case of helical blade withdrawal was found in the limited open reduction group, the incidence of complications was 3.85%（1/26）; while 2 cases of helical blade withdrawal , 5 cases of shortening of the lower limb , 3 cases of coxavarus and 1 case of delayed union occurred in the closed group, the incidence of complications was 37.93%（11/29）, with significant difference between the two groups（χ2=7.446，p =0.006）. [Conclusion] Compared with closed reduction for treating IFFs of AO/OTA type 31-A3, limited open reduction technique can achieve better effect of fracture reduction and internal fixation, with the advantages of shorter operation time, fewer fluoroscopy times, and lower postoperative complications.