Abstract:[Objective] To compare the clinical efficacy of proximal femoral nail anti-rotation (PFNA) with or without lateral wall re- construction for femoral intertrochanteric fractures. [Methods] A retrospective study was conducted on 60 patients who received PFNA for femoral intertrochanteric fractures complicated with lateral wall fractures in our department from January 2017 to June 2021. According to the preoperative doctor-patient communication, 31 patients underwent PFNA and lateral wall reconstruction with a locking plate (the recon- struction group), while the other 29 patients received PFNA alone (the non-reconstruction group). The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All the patients were operated on smoothly without nerve and vascular injury. Al- though there were no significant differences in operation time, intraoperative blood loss, total incision length, intraoperative fluoroscopy times, success rate of the first nail placement, screw blade length, incision healing grade and hospital stay between the two groups (P＞0.05), the reconstruction group resumed ambulation significantly earlier than the non-reconstructed group [(14.1±1.8) days vs (18.5±2.9) days, P＜ 0.05]. All patients in both groups were followed up for an average of (19.0±4.3) months, and the reconstruction group returned to full weightbearing activity significantly earlier than the non-reconstructed group [(13.6±3.4) weeks vs (18.5±2.9) weeks, P＜0.05]. The Harris score, hip extension-flexion range of motion (ROM) and adduction- abduction ROM significantly increased in both groups with postoperative time (P＜0.05), which in the reconstruction group proved significantly better than those in the non-reconstructed group at all time points accord- ingly (P＜0.05). Radiologically, there was no significant difference in reduction quality between the two groups (P＞0.05). At the last followup, the reconstruction group was also significantly superior to the non- reconstruction group in terms of neck-shaft angle (NSA) [(127.3± 2.7)° vs (124.8±1.7)°, P＜0.05] and extent of femoral head-neck shortening [(4.1±0.7) mm vs (5.1±0.6) mm, P＜0.05]. [Conclusion] The lat- eral wall reconstruction in PFNA fixation of femoral intertrochanteric fractures does enhance the stability of fixation, facilitate the function-al recovery of hip joint and reduce complications in this study.