Despite the advances in technique and implants available, the treatment of neglected, unstable, irreducible intertrochanteric fractures in the elderly remains to be a challenge. The purpose of this study is to compare the functional outcome, complication rate, revision rate and mortality rate between the use of cemented Bipolar Hemiarthroplasty (BPH) and Proximal Femoral Nail (PFN) in the treatment of neglected, unstable, irreducible intertrochanteric fractures in patients aged 65 years old and above. A total of 35 patients (17 for BPH, 18 for PFN) were gathered prospectively for this study. Results show that there was no difference in functional outcome, complication rate, and revision rate between the two groups. There was a higher amount of blood loss and more mortality in the BPH group. The use of cemented hemiarthroplasty is a viable option for the treatment of intertrochanteric fracture in elderly patients who have a higher amount of allowable blood loss and for patients compliant with necessary rehabilitation protocols. Given the distorted anatomy, it is more challenging to perform arthroplasty in intertrochanteric fractures. The level of skill required for this procedure is yet to be determined.