Objective To analyze the clinical characteristics, failure causes and revision methods of the patients undergoing revision surgery after failure of internal fixation for intertrochanteric fractures. Methods Clinical data of 8 patients who underwent revision surgery after internal fixation of intertrochanteric fractures in the orthopedic department of our medical center from September 2012 to September 2014 were collected and retrospectively analyzed. Their medical and surgical records, results of postoperative follow-up examinations, X-ray film and other detailed clinical data were employed to analyze the failure causes for internal fixation. Revision surgical strategies were analyzed and proposed. Results Among the 2 patients treated with plate, 1 experienced broken plate and the other fracture nonunion. In the 6 patients treated with proximal femoral nail/proximal femoral nail anti-rotation (PFN/PFNA), there were 3 cases of nail cut-out, 1 of cut-through, 1 of back screw, and 1 of broken screw. The reasons for failure of internal fixation included inappropriate position of screw (5/6), loss of support from the medial/lateral wall of the femur (6/8), non-anatomical reduction (6/8), excess dissection of soft tissue (1/8), and infection (2/8). For reasons of failure, revision procedures included total hip arthroplasty (5/8), plate fixation (1/8), PFNA fixation (1/8), and PFN fixation (1/8). Among them, 2 patients were treated with antibiotic-loaded cement in the first stage due to bone infection, and 1 patient was treated with autologous cancellous bone graft because of poor bone quality. Conclusion Failure of intertrochanteric fracture internal fixation attributes to multiple risk factors, mainly including inappropriate position of screw, poor reduction and loss of support of the medial/lateral wall of the femur. Therefore, anatomical reduction, proper selection and good placement of implants are important measures to prevent the failure of intertrochanteric fracture internal fixation. According to the reason of failure and condition of the patients, we need to choose an appropriate revision surgery procedure.