Abstract: Objective To investigate the effectiveness of proximal femoral nail antirotation for Asian(PFNA-Ⅱ) in the treatment of elderly patients with unstable intertrochanteric fracture.Methods A total of 103 elderly patients with unstable intertrochanteric fracture who were admitted to Xuzhou Central Hospital from April 2019 to April 2022 were enrolled and their clncial data were retrospectively analyzed. According to the internal fixation materials used, they were divided into two groups: group A(n=54, using PFNA-II) and group B(n=49, using proximal femoral anatomical locking plate). Then, both groups were compared for perioperative indexes, hip joint function, thromboelastography parameters coagulation reaction time(R value), coagulation formation time(K value), and blood clot formation rate(α angle), thigh pain, activities of daily living and complications.Results Group A showed remarkably shorter operation time, length of hospitalization stay and postoperative weight-bearing time, as well as less intraoperative blood loss than group B(P<0.05), but no statistical difference was found in fracture healing time between the two groups(P>0.05). Pain improvement in group A was significantly better than that in group B(P<0.05). There was no statistical difference in gait, functional activity, range of motion, dimension score of lower extremity deformity, and Harris total score between the two groups(P>0.05).After operation, the R value of the two groups was significantly lower than those before operation, and the α angle significantly increased. Group A presented significantly higher R value and lower α angle than group B(P<0.05). There was no statistical difference in K value between the two groups before and after surgery(P>0.05).The postoperative VAS scores of the two groups were significantly lower than those before surgery, but ADL scores were significantly higher than those before surgery. Group A presented significantly lower VAS score but higher ADL score than group B(P<0.05).The total incidence of complications was 5.56% in group A, and 8.16% in group B, without statistical difference(P>0.05).Conclusions Application of PFNA-Ⅱfor the treatment of unstable intertrochanteric fracture in elderly patients can effectively shorten operation time, with less intraoperative blood loss and less trauma, which is beneficial to reduce postoperative thrombosis and promote the recovery of patients.