PURPOSE: To investigate postoperative incidence of complications and functional results between two groups, primary bipolar hemiarthroplasty and internal fixation with compression hip screw on unstable intertrochanteric fractures of the femur with severe osteoporosis in elderly patients. MATERIALS AND METHODS: 78 cases treated under unstable intertrochanteric fractures of the femur with severe osteoporotic elderly patients from March 1997 to August 2001 who have been followed up for more than a year were evaluated retrospectively between the group of bipolar hemiarthroplasty, 38 cases out of 60 cases and group of compression hip screw, 40 cases out of 59 cases. The incidence of complications and functional ability according to Merle d'Aubigne scale and the mortality rate were compared using student t-test. RESULTS: The means of Merle d'Aubigne scale for the hemiarthroplasty group and the compression hip screw group were at the last follow up, 15.0 and 13.6 respectively. The differences were statistically significant (p=0.04). Bipolar group revealed significant differences in general (18%) and mechanical complications (5%) between two groups (p<0.05). The mortality rates were 28% and 22% respectively and there were no significant differences statistically (p>0.05). CONCLUSION: We consider that primary bipolar hemiarthroplasty would be better method in the treatment of the unstable femoral intertrochanteric fracture with severe osteoporosis but we need much longer follow up.