Purpose: To explore the clinical effects of the direct anterior approach (DAA) and the direct lateral approach in elderly patients with irreducible intertrochanteric fractures. Methods: A retrospective analysis method was used to collect samples of 18 elderly patients with irreducible intertrochanteric fractures of the femur admitted to our hospital from January 2020 to January 2023, and they were divided into a study group (n = 9) and a control group (n = 9) according to different surgical plans. Both groups of patients underwent internal fixation with proximal femoral nail anti-rotation (PFNA). The patients in the control group were treated through the direct lateral approach, and those in the study group were treated using DAA. The surgical conditions, recovery conditions, and indicators of postoperative complications were compared between the two groups. Results: The operation time and intraoperative blood loss of the study group were lower than that of the control group (P < 0.05); there was no significant difference in the degree of hip flexion and extension recovery between the two groups after surgery, as well as the functional scores (P > 0.05); the study group had a lower incidence of complication than the control group (P < 0.05). Conclusion: Compared with the direct lateral approach, the DAA to the hip joint in elderly patients with irreducible intertrochanteric fractures can shorten the operation time, reduce intraoperative blood loss, and shorten the recovery period of joint function. With a satisfactory prognosis and low incidence of complications, it can be promoted and applied in medical institutions.