Objective To compare the efficacy of internal fixation with PFNA and DHS +cannulated screw in the treatment of intertrochanteric fractures in the elderly. Methods A retrospective study was conducted to enroll patients with intertrochanteric fractures in the elderly from January 2014 to March 2018. Finally, 64 patients were included, including 24 patients treated with PFNA fixation(PFNA group), and 40 patients treated with DHS combined with cannulated screw(DHS+cannulated screw group). The duration of surgery, intraoperative blood loss, postoperative complications, fracture healing time and the last recorded hip Harris score were recorded. Results Compared with DHS+cannulated screw group, PFNA group had shorter duration of surgery, less intraoperative blood loss and lower postoperative complications(P <0.01). Moreover,fracture healing in the PFNA group was faster than that in the DHS +cannulated screw group, and the last recorded Harris score was higher(P<0.01). Conclusion For elderly patients with intertrochanteric fractures, internal fixation with PFNA has better efficacy and fewer complications than internal fixation with DHS combined with cannulated screw, and is worthy of clinical promotion.