Abstract: Objective To improve the prognosis of elderly patients with intertrochanteric fractures after internal fixation, and analyze the changes of hemorheology and bone metabolism after treatment with modified Fuyuan Huoxue decoction. Methods A total of 140 elderly patients with intertrochanteric fracture of the femur who were admitted to the People's Hospital of Yanggu County from January 2019 to September 2021 were selected. According to the random number table method, they were divided into two groups (n=70): a control group and a research group. Proximal femoral nail anti-rotation (PFNA) was conducted in both groups. The control group received postoperative conventional treatment combined with routine rehabilitation exercises, while the research group was treated with modified Fuyuan Huoxue decoction, in addition to the treatment in the control group. The patients were treated for two months, before follow-up visit for six months. The two groups were compared for the clinical effects six months after treatment, hemorheology indexes, clinical symptoms and signs before and after treatment for two months. Their hip bone mineral density and bone metabolism, recovery and complications during treatment were measured before and six months after treatment. Results Six months after treatment, the research group showed a higher total effective rate (97.14%) than the control group (85.71%, P<0.05). Compared with before treatment, two months of treatment resulted in decreases in whole blood viscosity (high, medium and low incision), whole blood reduction viscosity (high, medium and low incision), plasma viscosity, maximum swelling value, swelling value, and pain scores, where lower scores were seen in the research group (P<0.05). Compared with those before treatment, the levels of serum bone alkaline phosphatase (BALP) and osteocalcin (BGP) and bone mineral density (BMD) of healthy hip increased in both the groups six months after treatment, while these levels were higher in the research group (P<0.05). The study group showed shorter length of hospitalization, fracture healing and limb swelling subsiding (P<0.05). During the treatment, there was no statistical difference in the incidence of complications between the two groups (7.14% vs 8.57%, P>0.05). Conclusions Fuyuan Huoxue decoction is effective for the treatment of elderly patients with intertrochanteric fracture after internal fixation, which can improve the clinical symptoms and signs, adjust the hemorheological indexes and bone metabolism and hip bone mineral density, and improve recovery, with high safety.