Objective: To explore the safety and therapeutic effect of proximal femoral nail anti-rotation (PFNA) in elderly patients with intertrochanteric fracture of femur.Methods: 84 patients with intertrochanteric fractures of the femur admitted to Wuyang County Central Hospital in Luohe City from April 2023 to May 2025 were selected for the study. They were grouped using a computer-generated randomization method. The study group received PFNA treatment, while the control group received anatomical locking proximal femoral plate treatment. Each group consisted of 42 patients, and the safety of the treatments was analyzed.Results: The study group had fewer complications than the control group, with P < 0.05. The study group had shorter incision lengths and lower blood loss than the control group. The study group also had shorter operation times, hospital stays, and postoperative weight-bearing times than the control group, with P < 0.05. The study group had higher Harris Hip Scores than the control group, with P < 0.05.Conclusion: PFNA treatment for patients with intertrochanteric fractures of the femur yields significant efficacy. This technique features small incisions, minimal bleeding, and high safety, making it worthy of promotion.