Background: Intertrochanteric fractures, a common occurrence in the elderly population, pose significant challenges in orthopedic surgery due to their association with reduced mobility, prolonged rehabilitation, and increased morbidity and mortality. To compare the efficacy of Proximal Femoral Nailing (PFN) and Dynamic Hip Screw (DHS) fixation in the treatment of intertrochanteric fractures. Material and Methods: The current prospective, comparative clinical study was conducted at a tertiary care hospital and included 80 patients aged 18–80 years diagnosed with intertrochanteric fractures (AO/OTA types 31-A1 and 31-A2). Patients were randomized into two groups: PFN (n=40) and DHS (n=40). Baseline characteristics, operative variables, postoperative outcomes, and complications were recorded and analyzed using standard statistical methods. The primary outcomes included time to fracture union, operative duration, intraoperative blood loss, and functional outcomes assessed by the Harris Hip Score (HHS) at six months. Results: Both groups were comparable in terms of baseline characteristics. The PFN group demonstrated significantly shorter operative durations (58.45 ± 7.62 minutes vs. 72.38 ± 8.21 minutes, p < 0.001) and lower intraoperative blood loss (118.35 ± 15.42 mL vs. 190.52 ± 20.47 mL, p < 0.001) compared to the DHS group. The mean hospital stay was shorter for PFN patients (5.12 ± 1.03 days vs. 6.75 ± 1.28 days, p < 0.001). Faster fracture union was observed in the PFN group, with 75.00% achieving union within 12 weeks compared to 50.00% in the DHS group (p = 0.02). The mean HHS score at six months was higher in the PFN group (85.42 ± 5.73 vs. 79.62 ± 6.81, p < 0.001). The overall complication rate was lower in the PFN group (15.00% vs. 32.50%, p = 0.04). Conclusion: Proximal Femoral Nailing (PFN) demonstrated superior efficacy compared to Dynamic Hip Screw (DHS) fixation in the treatment of intertrochanteric fractures. PFN was associated with shorter surgical times, reduced blood loss, faster fracture union, improved functional outcomes, and fewer complications, making it the preferred choice, especially for unstable fracture patterns.