Objective: To analyze the risk factors for failure of internal fixation after closed reduction and internal fixation for treatment of senile intertrochanteric fracture. Methods: Retrospective analysis was performed on 232 elderly patients with intertrochanteric fracture who were treated with closed reduction dynamic hip screw (DHS) or proximal femoral anti-rotation nail (PFNA) fixation from January 2010 to January 2017. AO classification of fractures: 145 cases of stable fractures (A1.1 to A2.1) and 87 cases of unstable fractures (A2.2 to A3.3). Hip Harris scores and internal fixation status were recorded at the last follow-up, and factors that might affect the failure of internal fixation were analyzed by univariate and logistic regression analysis. Results: Till May 2018, 215 patients were followed up, with a follow-up rate of 92.67% (215/232), with a follow-up time of 15–39 months (an average of 25 months), and 17 patients were lost successively after 12 months. Of the 232 patients, 16 had internal fixation failure, with an incidence of 6.90%. There were 6 cases of DHS fixation failure and 10 cases of PFNA fixation failure. At the last follow-up (when 17 patients were followed up for 12 months), the average score of hip Harris was 81.9 points (58–90 points), with 42 cases, 160 cases, 13 cases and 17 cases of excellent, good, fair and bad, respectively, and the excellent and good rate was 87.07%. Logistic analysis results showed that osteoporosis (OR=267.31, P=0.002), tip distance (TAD) >25 mm (OR=341.45, P<0.001), unstable fracture (OR=22.19, P=0.020), functional reduction (OR=20.82, P=0.030), and combined internal and external fixation (OR=4.61, P=0.041) were independent risk factors for failure of intertrochanteric fracture of femur. Conclusion: Osteoporosis, TAD >25 mm, unstable fracture, functional reduction, and combined internal diseases can lead to failure of postoperative internal fixation for senile intertrochanteric fracture.