Abstract:[Objective] To investigate the clinical outcomes of extended proximal femoral nail anti-rotation (PFNA) with or without cerclages for femoral intertrochanteric and subtrochanteric fractures. [Methods] A retrospective study was done on 26 patients who received open reduction and internal fixation (ORIF) for femoral intertrochanteric and subtrochanteric fractures in our department from February 2018 to June 2020. According to the surgeon-patient discussion preoperatively, 13 patients had the fractures fixed by extended PFNA alone (non-cerclage group), while other 13 patients were fixed by extended PFNA combined with steel wire cerclages (cerclage group). The documents of perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had corresponding surgical procedures performed successfully. Although the non-cerclage group consumed significantly less total incision length [(8.4±1.7) cm vs (12.3±2.9) cm, P＜0.001], intraoperative fluoroscopy times [(49.2±21.5) times vs (62.6±15.3) times, P＜0.001] than the cerclage group, the cerclage group resumed partial weight bearing activity significantly earlier than the non-cerclage group [(29.0±7.2) days vs (59.7±14.8) days, P＜0.001]. The VAS and Harris scores, as well as hip extension-flexion range of motion (ROM) and internal-external rotation ROM significantly improved over time in both groups (P＜0.05). The cerclage group proved significantly superior to the non-cerclage group in terms of VAS score [(5.6±0.7) vs (7.3 ±1.0), P＜0.001], Harris score [(64.7±8.3) vs (53.1±9.6), P＜0.001], hip flexion-extension ROM [(83.2±18.9)° vs (54.7±22.3)°, P＜0.001], and internal-external rotation ROM [(46.4±13.7)° vs (35.8±15.1)°, P=0.017] 1 month postoperatively, as well as Harris score [(82.9±7.6) vs (69.5±10.3), P＜0.001] 6 months postoperatively. Regarding imaging, the cerclage group proved significantly superior to the non-cerclage group in fracture reduction quality based on Baumgaertner's criteria [excellent/good/ poor, (11/2/0) vs (3/4/6), P=0.002]. Compared with those preoperatively, the femoral shaft-neck angle (FSNA) and bilateral femur length discrepancy (BFLD) was significantly improved in both groups 1 week after operation and at the last follow-up (P＜0.05). The cerclage group proved significantly better than the non-cerclage group in terms of FSNA [(125.8±7.7)° vs (117.4±12.3)°, P=0.047] and BFLD [(3.0±2.1) mm vs (4.8±3.4) mm, P=0.049] at the latest follow-up, regardless of insignificant difference in fracture healing between the two groups (P＞ 0.05). [Conclusion] The extended PFNA combined with wire cerclages is considerably better in clinical consequences over the extended PFNA alone for treatment of femoral intertrochanteric and subtrochanteric fractures.