Background: cephalomedullary nailing has been the most often used surgical procedure for treating peritrochanteric femur fracture patterns. Both of these so-called long and short nails are utilized to repair fractures of the peritrochanteric femur. Patients and Methods: This study was a prospective interventional study including thirty older patients with unstable intertrochanteric fractures, 73.3% of them were males and 26.7% were females. Closed reduction and either long or short cephalomedullary Gamma nail fixation was used to treat the patients. Two groups of patients were assigned; group A patients were managed by short nails (15 patients) and group B with long nails (15 patients). Results: The short nail group had a significantly shorter operation time than long nail group and a lower rate of blood loss with no need for blood transfusion in either group. Radiation exposure was higher in the long nails group than in the short nail groups with p = 0.001. At the 6-month final follow-up, there wasn't statistically significant difference between the 2 groups regarding VAS score (p = 0.277), Harris Hip Score (p = 0.728), neck shaft angle (p = 0.848), and average time of union (p = 0.483). Conclusion: The use of long and short cephalomedullary Gamma nails in fixation of unstable intertrochanteric fractures in elderly achieved satisfactory clinical and radiological outcomes but short cephalomedullary gamma nailing can clearly reduce radiation exposure, operating time, and intraoperative blood loss.