204 patients with an unstable intertrochanteric hip fracture were randomized to undergo fixation using either an intramedullary implant or extramedullary implant. The purpose of this study was to compare clinical outcomes, including the lower extremity measure (LEM), functional independence measure (FIM), timed "up and go" tests (TUG), and a timed two-minute walk test, and radiographical outcomes, including tip-apex distance and femoral neck shortening, between groups. Follow-up was performed over a 12-month period postoperatively. Results demonstrated no significant differences between groups in any of the clinical/functional outcomes measured. Intramedullary nails demonstrated a significantly lower degree of femoral neck shortening after 12 months when compared to extramedullary implants.