Objective To compare the effect of reconstructing calcar femorale (locking proximal femur plate and auxiliary short reconstructed plate) and proximal femoral nail anti-rotation (PFNA) in the treatment of unstable femoral intertrochanteric fractures in elderly patients, and provide the basis for the choice of treatment methods. Methods Eighty cases of unstable intertrochanteric fractures admitted to the First People’s Hospital of Lianyungang from January 2014 to January 2016 were randomly divided into group A (40 cases) and group B (40 cases). The patients in the group A were treated with reconstruction of calcar femorale, those in the groups B were treated with PFNA. The clinical efficacy in the two groups were compared. Results All patients healed in stage Ⅰ, there was no significant difference in the efficacy rate between the two groups (P > 0.05). The beginning time of partial loading in the two groups had no difference (P > 0.05). The operation time, length of surgical incision and fracture healing time in the group A were shorter than those in the group B (P < 0.05), and the amount of bleeding was smaller than that in the group B (P < 0.05). The incidence of complications was not statistically different between the groups A and B (P > 0.05). Conclusions Both reconstruction of calcar femorale and PFNA are effective for the treatment of unstable femoral intertrochanteric fractures in elderly patients. However, PFNA with minimal invasion,little trauma and rapid healing should be preferred, and reconstruction of calcar femorale may be used as an effective supplement to PFNA.