Ninety-six elderly patients with stable intertrochanteric fractures (AO/OTA 31-A1 and A2) were randomized to receive either distal locked (n=48) or distal unlocked (n=48) proximal femoral nails. The primary outcome was operative time. Secondary outcomes included fluoroscopy time, incision length, blood loss, fracture union time, complication rates, functional outcomes (Harris Hip Score), and postoperative mobility. Outcomes were assessed up to 12 months postoperatively. Overall, the results of the study revealed that omitting the distal locking screw significantly reduced operative time, blood loss, and fluoroscopy exposure without affecting fracture healing or increasing complications. These findings suggest that distal unlocked proximal femoral nailing is a safe and efficient alternative for elderly patients with stable fractures.