This study investigates the sterile inflammatory response in elderly patients with subtrochanteric fractures (STFs) following surgical treatment. A retrospective, observational cohort study was conducted between January 2021 and October 2023, involving 143 patients diagnosed with acute STFs who underwent long Gamma Nail (LGN) fixation. Patients were divided into two groups based on the surgical reduction technique: closed reduction and internal fixation (CRIF) and open reduction internal fixation (ORIF). The study found statistically significant differences in various postoperative hematological-derived biomarkers between the two groups, including 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 revealed that NLR > 6.95 had the highest diagnostic ability (sensitivity 94.8%, specificity 70.6%). Multivariate regression analysis confirmed that these biomarkers can effectively assess the sterile immune response after orthopedic interventions. The study concludes that postoperative NLR, PLR, MLR, SII, SIRI, and AISI ratios are closely correlated with the magnitude of the sterile inflammatory response, which is influenced by the extent of surgical dissection during internal fixation procedures. These findings can aid orthopedic surgeons in making informed decisions about the choice of surgical technique based on the invasiveness of the reduction technique.This study investigates the sterile inflammatory response in elderly patients with subtrochanteric fractures (STFs) following surgical treatment. A retrospective, observational cohort study was conducted between January 2021 and October 2023, involving 143 patients diagnosed with acute STFs who underwent long Gamma Nail (LGN) fixation. Patients were divided into two groups based on the surgical reduction technique: closed reduction and internal fixation (CRIF) and open reduction internal fixation (ORIF). The study found statistically significant differences in various postoperative hematological-derived biomarkers between the two groups, including 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 revealed that NLR > 6.95 had the highest diagnostic ability (sensitivity 94.8%, specificity 70.6%). Multivariate regression analysis confirmed that these biomarkers can effectively assess the sterile immune response after orthopedic interventions. The study concludes that postoperative NLR, PLR, MLR, SII, SIRI, and AISI ratios are closely correlated with the magnitude of the sterile inflammatory response, which is influenced by the extent of surgical dissection during internal fixation procedures. These findings can aid orthopedic surgeons in making informed decisions about the choice of surgical technique based on the invasiveness of the reduction technique.