Objective To evaluate the efficacy of anatomic locking plate treatment for femoral intertrochanteric fractures with the most vulnerable lateral femoral wall. Methods Twenty patients with femoral intertrochanteric fractures were operated with anatomic locking plate during January 2012 and July 2013. All the postoperative function indexes were messured. All cases were followed up for 12-18 months. Results According to the Harris score, 17 cases were classified as excellent and 3 cases as good. All patients had good or excellent prognosis. Conclusions Anatomic locking plate treatment provides stable fixation with high efficacy. It has advantages to treat femoral intertrochanteric fractures with the vulnerable lateral femoral wall.