Objective To observe effect of reconstructing physiological fulcrum in the treatment of elderly patients with intertrochanteric fracture of the femur. Methods Clinical materials of 40 elderly patients with osteoporotic intertrochanteric fracture of femur in the Tongling City People's Hospital from October 2020 to October 2022 were retrospectively analyzed. Among them, 20 patients treated with proximal femoral nail anti-rotation (PFNA) were assigned to the PFNA group, and 20 patients treated with proximal femoral bionic nail (PFBN) were assigned to the PFBN group. The operation time, intraoperative blood loss, length of hospital stay, postoperative rehabilitation, and incidence of complications were compared between the two groups. Results The postoperative weight-bearing time in the PFBN group was (8.50±1.99) days, which was significantly shorter than (20.15±4.87) days in the PFNA group (P<0.05). There were no significant differences in operation time, intraoperative blood loss, length of hospital stay, fracture healing time, excellent and good rate of fracture reduction quality, and excellent and good rate of Harris score between the PFBN group and the PFNA group (P>0.05). During the follow-up period of 10 to 14 months, no patients had complications such as wound infection, bone nonunion, implant failure, or deep venous thrombosis. Conclusion Both PFBN and PFNA can effectively treat elderly patients with osteoporotic intertrochanteric fracture of femur. However, patients treated with PFBN can take bed-off activities earlier, which is beneficial for postoperative rehabilitation, and the reason may be related to the double triangular stable structure reconstructed by PFBN.