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Purpose : The purpose of this study is to assess the role of the lateral wall in post-operative clinical outcomes in patients with intertrochanteric fractures treated with the proximal femoral nail anti-rotation-Asia (PFNA-II). Methods: A cohort of 466 patients (OTA type 31A1 or A2) was divided into two groups: one was intact lateral wall group, and the other was fractured lateral wall group. Radiographic outcomes were measured by using the loss of neck-shaft angle (NSA), femoral neck shortening (FNS), and offset shortening (OS). Functional outcomes were assessed by using the Harris score and SF-36 Physical Component Summary (SF-36 PCS). Post-operative complications were recorded. Results: The fractured lateral wall group had a greater loss of NSA (mean [SD], fractured group (8.7°) [2.7°] vs intact group (4.8°) [2.8°]; mean difference, 3.3° [95% CI 2.9 to 3.8]; P < 0.001) compared with the intact lateral wall group. Similar results were found for FNS and OS. The fractured lateral wall group had a worse Harris scores at the three month follow-up (mean [SD] score, fractured group (66.6) [5.2] points vs intact group (71.3) [5.8] points; mean difference, − 3.3 points [95% CI − 3.9 to − 2.7]; P < 0.001) compared with the intact lateral wall group. Similar results were observed for Harris scores at the three and 12-month follow-ups and SF-36 PCS at the three, six and 12-month follow-ups. The fractured lateral wall group had a higher risk of post-operative complications compared with the intact lateral wall group. Conclusion: Among older patients with intertrochanteric fractures, the fractured lateral wall was associated with worse clinical outcomes compared with the intact lateral wall. Clinicians should pay attention to the lateral wall integrity in patients with intertrochanteric fractures treated with the PFNA-II. [ABSTRACT FROM AUTHOR]