One hundred eighteen patients with peri-trochanteric hip fractures were randomized to receive intramedullary nailing with either a single lag screw (n=54) or an additional anti-rotational screw (n=64). The primary outcome of interest was the incidence of postoperative complications. Secondary outcomes included radiographic parameters, operation time, radiation exposure, and clinical mobility scores. Outcomes were assessed for a minimum of three months. Overall, the results of the study revealed significantly more complications in the single-screw group (p < 0.05), particularly in unstable fractures. The addition of an anti-rotational screw reduced complications without significantly affecting operative parameters, suggesting its utility in unstable fracture patterns.