Objective: To analyze the clinical effect of PFNA and Wagner stem artificial femoral head replacement in the treatment of intertrochanteric fracture (IFF) of femur. Methods: 96 IFF patients admitted to our Department of Orthopedics from January 2022 to December 2024 were selected as the study objects. The patients were randomly divided into internal fixation group and femoral head replacement group, 48 cases in each group. Perioperative parameters, hip function [Harris hip function score (HHS)] and complications during hospitalization were recorded and compared between the two groups. Results: Compared with the femoral head replacement group, the operative time, incision length and intraoperative blood loss in the internal fixation group were significantly reduced, and the postoperative full weight-bearing time was significantly extended (P < 0.05). The HHS score of the internal fixation group at 6 months after surgery was significantly lower than that of the femoral head replacement group (P < 0.05). There was no significant difference in HHS scores 12 months after surgery between the two groups (P > 0.05). There was no significant difference in the incidence of complications between the two groups (P > 0.05). Conclusion: In the treatment of IFF, PFNA internal fixation and Wagner stem artificial femoral head replacement can achieve good long-term results. However, the operation time of PFNA internal fixation is short and the trauma is small. In contrast, Wagner stem artificial femoral head replacement can be used earlier for weight training, and the recent results are relatively good.