40 patients with unstable intertrochanteric fractures with compromised lateral wall were randomized to determine a superior method of fixation between proximal femoral nail (PFN) and contralateral reverse distal femoral locking compression plate (reverse-DFLCP). Patients were monitored over 1 year and were evaluated based on intraoperative measures, clinical outcomes, and rate of mechanical failure. The evidence presented in this trial demonstrated that PFN resulted in a shorter duration of surgery, fluoroscopy time, and less blood loss. PFN patients also experienced significantly fewer failures, and demonstrated favorable clinical outcomes in the HHS and SF-12.