The purpose of this study was to compare the functional outcome of patients with ipsilateral intertrochanteric and femoral shaft fractures treated with a reconstruction nail versus a sliding hip screw and retrograde nail.Retrospective cohort study.Two level 1 trauma centers.Twenty-six patients with ipsilateral intertrochanteric and femoral shaft fractures treated between 1993 and 2003 with a reconstruction nail (n=13) or with a sliding hip screw and retrograde nail (n=13).Internal fixation with a reconstruction nail or a sliding hip screw and retrograde nail.Functional outcome was measured using the Short Form-36 (SF-36), Short Musculoskeletal Functional Assessment (SMFA), and Lower Extremity Functional Scale (LEFS).The average time to follow-up was 49.6 months. Functional outcome was significantly better in the sliding hip screw with retrograde nail group for the role emotional (P=0.001) and mental component scores (P=0.016) of the SF-36. This group also scored better on the LEFS, although not reaching statistical significance (P=0.099).For most outcome measures, no significant differences in functional outcome scores were observed between the 2 treatment groups. The results of this study suggest the need for a randomized controlled trial with a larger sample size to more definitively compare the 2 fixation constructs.