Unstable femoral intertrochanteric fractures are characterized by comminution of the posteromedial cortex, resulting in a fragment of variable size containing the lesser trochanter. Need for fixation of the fracture fragment of lesser trochanter remained controversial. We assessed the superior and medial migration of the fracture fragment of lesser trochanter, bone union, change of hip flexor power, limitation of motion and clinical results in a 29 unstable femoral intertrochanteric fractures which had been internally fixed with gamma interlocking nail (14 cases), compression hip screw (10 cases) and anatomical bent plate (5 cases). The fracture fragment of lesser trochanter was fixed with long trans-fixation screw in the cases of the anatomical bent plate. Superior migration of the fracture fragment of lesser trochanter is statistically different between Gamma interlocking nail and the other operations (P<0.05). Medial migration, bone union, change of hip flexor power, LOM and clinical results are not statistically different in the each operations (P>0.05). Although the stability could be provided by trans-fixation of the fracture fragment of lesser trochanter because the fragment acts as a buttress, clinical results was not influenced whether the fixation of the fracture fragment of lesser trochanter was done or not. We conclude that additional trans-fixation screw doesn t need if major fracture site was firmly fixed through any operation.