| Objective To investigate the methodology and efficacy of the treatment on unstable osteoporotic intertrochanteric fractures in the elderly. Methods A total of 194 elder patients, who accepted operation of proximal femoral nai) anti-rotation (PFNA)，or dynamic hip screw (DHS)，or hip replacement, or proximal femur locking compress plate (PF-LCP) for unstable intertrochanteric fractures in our hospital from January 2005 to May 2015，were retrospectively analyzed. The operation time, amount of bleeding, time of hospital stay, ambulation time, score of Harris，and complication, etc.，were evaluated. Results The surgery and hospitalization time was the shortest in PFNA group, and followed by GTF prosthetic group，PF-LCP group, and DHS group (P <0. 01). The amount of bleeding was the lowest in PFNA group, and it was no statistical difference among joint replacement group, PF-LCP group, and DHS group. The ambulation time was the shortest in GTF prosthetic group, and followed by PFNA group, PF-LCP group, and DHS group, with no statistical difference. Harris score was the highest in GTF prosthetic group, and followed by PFNA group, PF-LCP group, and DHS group after 1 month of operation ( P <0. 01 )，and it was not significantly different among the 4 groups after 6 months of operation (P >0. 01). Conclusion The key of treatment for elderly patients with femoral intertrochanteric unstable fracture is how to reduce operation risk，to shorte the ambulating time，and to avoid complications. PFNA should be preferred for the patients with better physical condition，low degree of osteoporosis, and lighter degree of fracture comminution. On the contrary, hip arthroplasty has more advantage ior patients with severe osteoporosis and heavy fracture comminution degree, and DHS needs to be chosen carefully. |