Objective To investigate the efficacy and postoperative safety of small incision proximal femoral nail internal fixation in the treatment of intertrochanteric fracture. Methods From June 2015 to October 2019, in our hospital, 150 patients with intertrochanteric fracture were selected as the research objects, and according to the stochastic indicator method, they were divided into a small incision group (75 cases) and a control group (75 cases). The patients in the control group received the proximal femoral reconstruction nail fixation treatment, and the patients in the small incision group were given the small incision proximal femur intramedullary nail fixation treatment. The clinical curative effects, operation time, intraoperative blood loss, bed activity time and hospital stay, the VAS scores, Harris scores, and the incidence of complications of the two groups were observed and compared between the two groups. Results The effective rate of the small incision group was 96.00%, higher than that of the control group (90.67%), and the difference was statistically significant (χ2=8.917, P=0.012). In the small incision group, the operative time , intraoperative blood loss , the time of getting out of bed and the hospitalization time were all lower than those in the control group , and the differences were statistically significant (t=18.53, 33.64, 19.24, 18.07, all P<0.01). there="" were="" no="" significant="" differences="" in="" the="" average="" preoperative="" vas="" score="" and="" harris="" score="" between="" the="" two="" groups="" both="" p="">0.05). After the treatment, the average VAS score of the small incision group (2.42±0.74) was lower than that of the control group (4.68±0.98), and the Harris score of the small incision group (86.34±12.11) was higher than that of the control group (78.51±10.69), and the differences were statistically significant (both P<0.05). The incidence of adverse reactions in the small incision group was 4.00%, which was lower than that in the control group (14.67%, χ2=5.042, P=0.025). Conclusion The small incision proximal femoral anti-rotation intramedullary nail internal fixation in the treatment of intertrochanteric fracture of femur has a significant effect, which can significantly reduce intraoperative blood loss, shorten the length of hospitalization, improve hip joint function, and it also has fewer complications. Therefore, it is worthy of further clinical research.