Introduction: Dynamic hip screw was commonly recommended and practiced as a choice of treatment for Intertrochanteric fracture recently the trends have changed towards intramedullary nailing along with sliding screw. Internal fixation is appropriate choice for intertrochanteric fracture; optimal fixation is based on stability of fracture. A new method for intertrochanteric fractures treatment involves the use of an intramedullary nail that interlocks proximally into the femoral head was in traduced in early 1990s. Methods: Study will be prospective, time bound, hospital based, randomized comparative study. Cases satisfying the inclusion criteria admitted in AMC during the study period of October 2016 to October 2018 will be included. Results: Total of 50 patients were treated for unstable intertrochanteric fracture among which 25 were treated with intramedullary nail (TFN, PFN) and 25 patients with extramedullary fixation (Dhs), among which intramedullary fixations showed better results in terms of functional outcome and clinical outcome compared to extramedullary group. in terms of duration of surgery, blood loss intramedullary group were better compared to extramedullary group. In terms of complete union of fracture and functional out come using Harris hip score at 1month and 6 month results were similar in both groups. But intramedullary group had 19 of excellent outcome, 6 of good, 0 fair and extramedullary 10 excellent 11 good and 4 fair results, and one case of Dhs had complication of screw cut out. Conclusion: Taking all parameter into consideration intramedullary nail is preferred choice of treatment for unstable intertrochanteric fracture because of bio mechanical advantage.

Keywords: Unstable intertrochanteric fracture; Extramedullary, Intramedullary; Harris hip score.