Background: Trochanteric femoral fractures frequently occur in older patients and can result from either high-energy or low-energy trauma, or may be due to pathological conditions. Hip fractures, particularly in the elderly, are significant contributors to elevated mortality and morbidity rates. Given their reduced physical capacity, presence of systemic diseases, and heightened susceptibility to environmental hazards, even minor trauma can lead to unstable femoral trochanteric fractures in this age group. This study aims to compare the functional outcomes of short versus long proximal femoral nails in the treatment of intertrochanteric fractures. Methods: This randomized controlled trial was carried out at the Department of Orthopedics, GMERS Medical college, Valsad. Results: The average surgery duration for the long PFN group was 80.50 ± 9.45 minutes, while for the short PFN group, it was 52.65 ± 8.01 minutes. The difference between these durations is extremely statistically significant, with a two-tailed P value of <0.001. Additionally, the mean intraoperative blood loss was 334.3 ± 29.63 ml for the long PFN group and 174 ± 24.22 ml for the short PFN group. Limb shortening was observed more frequently in the short PFN group compared to the long PFN group. Conclusion: Both long and short intramedullary nails are viable options for internal fixation of femoral intertrochanteric fractures. However, the long nail tends to reduce the risk of refracture and postoperative hip pain, while the short nail offers benefits such as shorter surgical time, reduced blood loss, and less fluoroscopic time.