This review was conducted to compare between arthroplasty and proximal femoral nail in fixation of unstable intertrochanteric fractures of elderly patients. Randomized controlled trials and quasi-random studies comparing the results of arthroplasty and proximal femoral nail fixation of unstable intertrochanteric fractures in the elderly published studies from 2010 to 2017. 18 articles were found matching our inclusion criteria. 7 of them were comparative. 11 studies were non-comparative. PFN was with relatively lower post-operative mortality and better functional outcomes PFN establishes itself as a better modality than hemiarthroplasty in unstable intertrochantric fractures in the elderly. Hemiarthroplasty should ideally be reserved for the patients who have lower life expectancies and require immediate weight bearing and mobilization.