PURPOSE: To compare the radiological and clinical results of Wayne-County reduction with anatomical reduction in treatment of the intertrochanteric fractures of the femur in elderly patients. MATERIALS AND METHODS: Among one hundred-three of intertrochanteric fractures treated with 135- degree angled compression hip scresw, eighty three cases treated by Wayne-County reduction (Group 1, 42 cases) and anatomical reduction (Group 2, 41 cases) with at least 1 year follow-up were reviewed. The average pateint ages were 72.4 (65~92) in group 1, 71.6 (65~89) in group 2, respectively. 33 cases (75.2%) in group 1 and 31 cases (77.5%) displayed unstable fractures by Jensen classification. The radiological observation was included neck-shaft angle, penetrating length of lag screw into head, sliding length of lag screw and time of bony union. The clinical results were evaluated by Koval criteria, Kyle's functional evaluation, leg length inequality and complications. RESULTS: There were no significant changes between group 1 and group 2 in stable fractures in the radiological and clinical results. In unstable fractures, the neck-shaft angle averaged 132.2 degree in group 1 and 129.4 degree in group 2 in the final follow-up films. The penetrating length of lag screw into head were 2.2 mm in group 1 and 3.1 mm in group 2 (p<005). But there were little differences in the sliding length of lag screw, the time of bony union and complication rates between groups. In post- operative evaluation of walking abilility by Koval, 31 patients (73.8%) in group 1 and 28 (68.3%) recovered the activity level before injury by the postoperative 1 year follow-up. Leg length discrepancy at final follow-up was 4.1±6 mm shortening in group 1 and 6.5±8 mm in group 2, respectively. CONCLUSION: Both Wayne-County reduction and anatomical reduction had a favorable results after treatment of stable intertrochanteric fractures of the femur, but Wayne-County reduction may be a better method in treatment of unstable fractures, especially in elderly patients, in which it is difficult to obtain anatomical reduction.