Abstract: Objective To explore the effect of modified proximal femoral nailing antirotation (PFNA) intramedullary fixation for osteoporotic intertrochanteric fractures in elderly patients. Methods Eighty-four cases of senile osteoporotic intertrochanteric fractures in our hospital between June, 2014 and December, 2014 were enrolled and assigned into study group and control group according to the document order, with 42 cases in each group. The control group was treated with conventional proximal femoral nailing antirotation intramedullary fixation, while the study group with modified proximal femoral nailing antirotation intramedullary fixation, and all patients were followed up for 10 months. The operation, hip function, incidence of complications, the activities of daily living (Barthel Index score) and hip function score (Harris score) at admission and during the follow-up were compared between the two groups. Results The operation duration, intraoperative blood loss, time to postoperative ambulation, and time for fracture healing in the study group were less than those in the control group (P < 0. 05). There was no significant difference in BI score and Harris score between the two groups before the surgery (P > 0. 05). BI scores and Harris scores of both groups were higher than those before the operation (P <0. 05), and the BI scores and Harris scores of the study group were higher than those of the control group (P < 0. 05). The excellent and good rate of hip joint function in the study group was 92. 86% (39/42), which was higher than that in the control group (71. 43%, 30/42), P < 0. 05. The incidence of complication in the study group was 9. 52% (4/42), which was lower than that in the control group (28. 57%, 12/42), P < 0. 05. Conclusion The effect of modified proximal femoral nailing antirotation intramedullary fixation for osteoporotic intertrochanteric fractures in elderly patients is significant, it can reduce the operation duration, blood loss and rehabilitation time, improve hip function and activities of daily living, with high security.