Sixty elderly patients with AO type 31-A1.2 to 31-A2.2 pertrochanteric femur fractures were randomized to receive either intramedullary nailing (n=30) or dynamic hip screw fixation (n=30). The primary outcome was the postoperative change in serum IL-6 levels, with secondary outcomes including IL-1β, IL-8, IL-10, C-reactive protein (CRP), creatine kinase (CK), and visual analog scale (VAS) pain scores. Outcomes were assessed preoperatively and at 24, 48, and 72 hours postoperatively. Overall, the results revealed that IL-6 levels were significantly higher in the IM nail group compared to the DHS group at all postoperative time points (adjusted model, p=0.03), whereas no significant differences were found for other biomarkers. The findings suggest that DHS may provoke a less intense inflammatory response than IM nailing, supporting its use in frail elderly patients.