We report the results of a prospective randomized clinical trial comparing the Gamma 3 nail with the ACE trochanteric nail for the treatment of pertrochanteric femoral fractures. One hundred and twelve consecutive patients were enrolled in the study: 61 patients were treated with the Gamma 3 nail, 51 with the ACE trochanteric nail. The two groups were matched for age, fracture type and preoperative Merle d'Aubigné hip score. All patients were followed up clinically and radiographically on a regular basis between 6 weeks and one year postoperatively. Twenty-six patients (23%) died within the first postoperative year. Six patients were lost to follow-up. In each group, two patients were revised due to mechanical failure. Nonunion did not occur. The mean postoperative hip scores in the Gamma 3 and the ACE group were 14.19 and 14.12 respectively, with no significant difference (p = 0.92). Walking ability was adequately restored in approximately 80% of the patients. Both implants appeared as safe and effective methods of treatment for intertrochanteric hip fractures.