This study investigates the relationship between the invasiveness of surgical reduction techniques and the magnitude of sterile inflammatory response in elderly patients with subtrochanteric femur fractures (STFs). A retrospective observational study of 143 patients who underwent long Gamma Nail (LGN) fixation for STFs was conducted. Patients were divided into two groups based on the reduction technique: closed reduction and internal fixation (CRIF) and open reduction and internal fixation (ORIF). The study found statistically significant differences between the groups in terms of days to surgery, length of hospital stay, duration of surgery, and postoperative hemoglobin levels, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI). Receiver operating characteristic (ROC) curve analysis showed that all ratios had high diagnostic ability, with NLR > 6.95 being the most reliable. A multivariate regression model confirmed that these biomarkers can assess the sterile immune response after orthopedic interventions. Postoperative NLR, PLR, MLR, SII, SIRI, and AISI ratios were closely correlated with the magnitude of the sterile inflammatory response due to the extent of surgical dissection. The study highlights the importance of these biomarkers in assessing the impact of surgical trauma on the immune system in elderly patients with STFs. The findings suggest that these markers can be used to guide surgical decisions and predict outcomes in patients with STFs. The study also notes the limitations of the research, including the inability to assess the consequences of increased sterile inflammatory response on postoperative complications, morbidity, and mortality. Future prospective studies are needed to determine the prognostic and therapeutic utility of these parameters.This study investigates the relationship between the invasiveness of surgical reduction techniques and the magnitude of sterile inflammatory response in elderly patients with subtrochanteric femur fractures (STFs). A retrospective observational study of 143 patients who underwent long Gamma Nail (LGN) fixation for STFs was conducted. Patients were divided into two groups based on the reduction technique: closed reduction and internal fixation (CRIF) and open reduction and internal fixation (ORIF). The study found statistically significant differences between the groups in terms of days to surgery, length of hospital stay, duration of surgery, and postoperative hemoglobin levels, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI). Receiver operating characteristic (ROC) curve analysis showed that all ratios had high diagnostic ability, with NLR > 6.95 being the most reliable. A multivariate regression model confirmed that these biomarkers can assess the sterile immune response after orthopedic interventions. Postoperative NLR, PLR, MLR, SII, SIRI, and AISI ratios were closely correlated with the magnitude of the sterile inflammatory response due to the extent of surgical dissection. The study highlights the importance of these biomarkers in assessing the impact of surgical trauma on the immune system in elderly patients with STFs. The findings suggest that these markers can be used to guide surgical decisions and predict outcomes in patients with STFs. The study also notes the limitations of the research, including the inability to assess the consequences of increased sterile inflammatory response on postoperative complications, morbidity, and mortality. Future prospective studies are needed to determine the prognostic and therapeutic utility of these parameters.