Intertrochanteric femoral fractures are the most important health problems among the elder population, which orthopedic surgeons encounter. They make up 50% of all hip fractures. Many of these fractures are stable two part fractures that can be treated satisfactorily with a dynamic hip screw. But 35–40% are unstable three and four part fractures that are associated with high rates of morbidity and mortality. The reported overall failure rate with internal fixation in intertrochanteric fractures is 3–16.5%. The rate is higher in unstable fractures. Due to high failure rate and complications associated with internal fixation, many authors have used hemiarthroplasty and total hip arthroplasty as primary treatment of these fractures. The aim of our work is to compare the results of management of unstable three and four parts intertrochanteric fracture of the femur by either fixation by dynamic hip screw or primary bipolar hemiarthroplasty as regarding return to pre fracture level of activity, hip function, one year mortality and complications rate.