Objective To compare the outcome of proximal femoral nail antirotation （PFNA）and third generation of Gamma nail （TGN） in the treatment of femoral intertrochanteric fracture in the elderly. Methods From January 2007 to June 2008, the patients with intertrochanteric fractures were divided into PFNA group （ n = 55 ） and TGN group （ n = 52 ） randomly. The two treatment groups were comparable in aspect of general data. The clinical data of surgical trauma, complications and postoperative function of the two groups were compared in our study. Results The mean operation time was （66.6 ± 15.4） min in PFNA group and （73. 1 ± 20.8 ） min in TGN group （P 〉 0. 05 ）. The mean intraoperative blood loss differed significantly, （219.5 ± 107.5 ） ml in PFNA group compared with （269.0 ±123.9） ml in TGN group （ P 〈 0. 05 ）. The mean fluoroscopy time was （ 2.97 ± 1.14 ） min in PFNA group and （3.43 ± 1.18） min in TGN group （P〈0.05）. Unilateral femoral shaft splits at the distal end of the nail was observed intra-operatively in four patients of the PFNA group and in one of the TGN group,with no statistical difference between two groups. Of all, 91 patients （ n =46 in the PFNA group and n =45 in the TGN group） were followed up for a duration of （ 17.5 ±3.69） months. There was one re-fracture and one implant failure during the follow up period in PFNA group, which was not found in TGN group. Fiftyone patients recovered to normal activity status, including 27 in the PFNA group and 24 in the TGN group,with no statistical differences. Conclusions Intertrochanteric fracture can be treated successfully with PFNA and TGN. There is no significant difference in complications and functional outcome between the two groups. However, PFNA takes advantages of less blood loss, less operative time and less fluoroscopy time over TGN.