Objective To compare the effectiveness of proximal femoral nail antirotation (PFNA) and reconstruction nail with minimally invasive technique for ipsilateral femoral shaft and extracapsular hip fractures in young and middle-aged patients. Methods Sixty-nine young and middle-aged patients with ipsilateral femoral shaft and extracapsular hip fractures were treated between January 2000 and August 2010, and their data were analyzed retrospectively. Of them, fractures were fixed by reconstruction nail in 44 cases (reconstruction nail group) and by PFNA in 25 cases (PFNA group). There was no significant difference in gender, age, weight, injury cause, fracture type, or disease duration between 2 groups (P gt; 0.05). The operation time, blood loss, fracture healing time, complications, and functional outcomes were compared between 2 groups to evaluate the effectiveness. Results The operation time and blood loss in the PFNA group were significantly less than those in the reconstruction nail group (P lt; 0.05). The follow-up time was 12-38 months (mean, 20 months ) in the PFNA group and was 12-48 months (mean, 22 months) in the reconstruction nail group. No complication occurred as follows in 2 groups: wound infection, deep venous thrombosis, pulmonary embolism, breakage of the implants, avascular necrosis of the femoral head, or serious rotation and shortening deformity of lower limbs. In the PFNA group and the reconstruction nail group, 1 patient underwent technical difficulty in nail implant and 7 patients underwent technical difficulty in proximal locking screw, respectively; 3 patients and 6 patients had intra-operative iatrogenic fracture of femoral shaft, respectively; and delayed union of femoral shaft was observed in 1 patient and 2 patients, respectively. The complication rate was 20% (5/25) in the PFNA group and 34% (15/44) in the reconstruction nail group, showing no significant difference (χ2=1.538, P=0.215). No significant difference was found in fracture healing time between 2 groups (P gt; 0.05). At last follow-up, there was no significant difference in Harris hip score and Evanich knee score between 2 groups (P gt; 0.05). Conclusion PFNA or reconstruction nail with minimally invasive technique is a good method to treat ipsilateral femoral shaft and extracapsular hip fractures, but the PFNA is superior to the reconstruction nail because of simple operation.