• Lesser trochanter displacement <1 cm was associated with faster early functional recovery (shorter time to straight leg raise and ambulation) and higher Harris scores up to 6 months postoperatively.
• No significant differences in fracture healing time or long-term (≥9 months) hip function were observed between displacement groups.
• Routine fixation of the lesser trochanter is not recommended for elderly patients, but individualized fixation may benefit those with high early functional demands.
• The study supports minimizing surgical trauma by avoiding unnecessary reduction, aligning with enhanced recovery after surgery principles.