72 elderly patients with an unstable intertrochanteric fracture were randomized to receive traction table facilitated intramedullary nailing or manual traction intramedullary nailing. The purpose of this study was to compare the two methods of traction in terms of their surgical, functional, and radiographic outcome. Duration of preparation and total anesthesia time were significantly shorter in the manual traction group, but significantly more assistants were needed compared to the traction table group. All other measured outcomes, including duration of surgery, fluoroscopy time, estimate blood loss, reduction and fixation quality, postoperative hospital stay, Harris Hip Score and ambulation score at 6 months, superficial wound infection rate, and radiological malunion rate were comparable between groups.