Seventy-five patients with intertrochanteric femur fractures were randomized to receive either standard Proximal femoral nail (PFN) (n=25), modified short PFN (MS-PFN) (n=25), or PFN-A2 (n=25). The primary outcome was functional outcome measured by Harris Hip Score. Secondary outcomes included radiological union time, intraoperative blood loss, operating time, and post-operative complications such as anterior thigh pain, screw cut-out, and infection. Outcomes were assessed at 6 weeks, 12 weeks, 6 months, and 12 months postoperatively. Overall, the results revealed that the PFN-A2 group had significantly better functional scores, shorter union times, and less intraoperative blood loss than the other two groups. PFN-A2 was associated with superior clinical outcomes, though anterior thigh pain was more common with longer nails.