205 patients suffering from unstable (AO-A2) intertrochanteric hip fractures were randomized to compare the clinical and radiographic outcomes associated with intramedullary and extramedullary device fixation. Patients were assessed over 12 months, and were evaluated using the Lower Extremity Measure (LEM), a 2-minute walk test, the Timed Up and Go (TUG) test, the functional independent measure (FIM), and a Trendelenburg test. Radiographs were conducted for tip-to-apex distance (TAD), femoral neck shortening, and heterotopic ossification. Results from 168 patients who completed final follow-up indicate that intramedullary and extramedullary fixation present comparable clinical outcomes. Intramedullary devices are associated with less femoral neck shortening, while extramedullary devices contribute to less Brooker stage 1 and 2 heterotopic ossification.