OBJECTIVE: To explore the closed-replacement technique of proximal femoral rotation-proof intramedullary nailing (PFNA) for the treatment of intertrochanteric fractures in the elderly, and to summarize the related experience. METHODS: From January 2011 to December 2014, 98 cases of femoral intertrochanteric fractures were treated with closed reduction PFNA surgery, 37 men and 61 women; age ranged from 63 to 101 years, with an average of 80.6 years. The fractures were typed by AO: 60 cases of type 31A2 and 38 cases of type 31A3; by modified Evans’ typing: 25 cases of type IIA, 31 cases of type IIB, and 42 cases of type III. The patients’ imaging data were evaluated preoperatively, and closed repositioning was performed by traction, internal rotation, posterior support and prying, and the appropriate ones were selected for internal fixation with PFNA. The Fogagnolo criteria were applied to evaluate the quality of the reset, and the Harris score was used to assess the function of the hip joint. RESULTS: Ninety patients (91.3%) were followed up for 12 to 48 months, with a mean of 27.4 months. The fracture healing time ranged from 8 to 16 weeks, with a mean of 10 weeks. Patients were able to walk with full weight bearing at an average of 8 weeks (6 to 16 weeks) after surgery. No infection, deep vein thrombosis, hip inversion deformity, femoral head cut and broken nail occurred. Evaluation of fracture repositioning: 78 cases were excellent and 12 cases were acceptable. The efficacy was evaluated according to the Harris hip function score: excellent in 56 cases, good in 20 cases, and moderate in 14 cases, with an excellent rate of 84.4%. Conclusion With the introduced repositioning technique, the fracture can be well repositioned and the PFNA can be successfully applied to minimally invasive treatment of intertrochanteric fracture of the femur.