Objective: To compare and analyze the efficacy of Asian proximal femoral nail antirotation II (PFNA-II) internal fixation in different surgical positions in the treatment of senile intertrochanteric fractures. Methods: The clinical data of 90 elderly patients with intertrochanteric fractures treated in Jiangyin Hospital of Traditional Chinese Medicine from October 2018 to October 2020 were retrospectively analyzed. All patients received PFNA-II internal fixation. Forty-three patients placed supine on an orthopedic traction bed were included in the control group, and 47 patients in the lateral decubitus position on the common operating bed were included in the study group. The operation conditions, fracture healing time, postoperative fracture reduction quality, hip joint function before and after the surgery, quality of life, and postoperative complication rates were compared between the 2 groups. Results: The body positioning time and operation time of the study group were shorter than those of the control group, and the length of surgical incision and intraoperative blood loss were less than those of the control group (all P<0.05). The hip pain, function, and mobility scores of the study group were higher than those of the control group at the 12th month after the surgery, and the deformity score was lower than that of the control group (all P<0.05). The quality of life of the study group at the 12th month after the surgery were higher than those in the control group (all P<0.05). Conclusion: PFNA-II internal fixation in the lateral decubitus position of the common operating bed for the treatment of senile intertrochanteric fractures is simple and has a small incision, which can shorten the operation time and promote the recovery of hip joint function, thereby improving the quality of life of patients, with fewer complications, and is safe and reliable.