We made a randomized prospective comparison of the compression hip screw and the Gamma nail for the internal fixation of 60 intertrochanteric fractures to compare perioperative details and to analyze radiographic and clinical results in elderly patients. The operation time for Gamma nail group was shorter than for CHS group and also the intraoperative blood loss was lower in the Gamma nail group. And the Gamma nail enabled earlier ambulation. We found no significant difference of the union time and the sliding length of lag screw between two groups. The decrease of neck shaft angle in the Gamma nail group was significantly smaller than the CHS group. There was no significant mechanical complication in the Gamma nail group such as a fracture of the femoral shaft or fixation failure. We obtained satisfactory results on treatment of elderly patients with intertrochanteric fracture of femur using Gamma nail. So we consider that in the treatment of intertrochanteric fractures of geriatric patients, the Gamma nail would be more efficient than the CHS.