Background: Intertrochanteric fractures are common in elderly individuals, typically resulting from low-energy trauma. While Dynamic Hip Screws (DHS) were previously considered the gold standard for stable fractures, they have shown limitations in unstable fractures. Proximal Femoral Nail (PFN) and Proximal Femoral Nail Anti-Rotation (PFNA2) are now widely used, but their comparative efficacy remains a subject of debate.Objective: To compare the functional, radiological, and complication outcomes of PFN versus PFNA2 in the treatment of unstable intertrochanteric fractures in elderly patients.Methods: A prospective randomized comparative study was conducted at Karwar institute of medical sciences, Karwar from April 2023 till November 2024, including 30 patients with unstable intertrochanteric fractures (15 in each group). Patients were followed up at 6 weeks, 3 months, 6 months, and 1 year. Functional outcomes were assessed using the Harris Hip Score (HHS), while radiological outcomes were evaluated based on bone union time. Postoperative complications and surgical parameters were also recorded.Results: The mean age of patients in the PFN and PFNA2 groups was 71.47±7.72 and 70.17±8.96 years, respectively (p>0.05). The mean Harris Hip Score showed significantly better improvement in the PFNA2 group compared to the PFN group (p<0.05). Radiological bony union time showed no significant difference between the two groups (p=0.84). However, operation time and fluoroscopic exposure were significantly lower in the PFNA2 group (p=0.0001). Postoperative complications were observed in 3 (23.08%) PFN cases and 1 (7.7%) PFNA2 case (p<0.05).Conclusion: While both implants yield similar radiological outcomes, PFNA2 provides superior functional recovery, reduces operative duration, and minimizes fluoroscopic exposure. Additionally, the PFNA2 group had fewer postoperative complications, making it a preferable choice for managing unstable intertrochanteric fractures.