Abstract: Objective To compare the clinical effectiveness of proximal femoral nail anti-rotation and bipolar hemiarthroplasty for proximal femoral fracture. Methods Retrospective analysis was performed, where 159 patients with proximal femoral fractures in the Affiliated Hospital of Xuzhou Medical University were selected. According to their surgical methods, they were divided into two groups: a proximal femoral nail anti-rotation (PFNA) group and a bipolar hemiarthroplasty (BH) group. Both groups were compared for their therapeutic effectiveness. Results The PFNA group showed remarkable decreases in the operation time, intraoperative blood loss, length of incision and postoperative drainage volume, as well as increases in weight-bearing time, compared with the BH group (P<0.05). There was no significant difference in the length of hospitalization stay, one-year Harris score and the incidence of early complications between the two groups. But the incidence of late complications in the BH group was significantly higher than that in the PFNA group. Conclusions Both proximal femoral nail anti-rotation and bipolar hemiarthroplasty have their own advantages. It is necessary to strictly follow the surgical indications to select, with respect to patient conditions.