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Background: The aim of this study was to evaluate the outcome of internal fixation in comparison with primary cemented bipolar (PCB) hemiarthroplasty in elderly patients with unstable intertrochanteric fracture. Methods: A prospective cohort multicentre study compared cemented bipolar (n=60) to osteosynthesis (n=57) in unstable intertrochanteric fracture (AO/OTA classification) in the elderly. Peri-operative mortality, complications and functional outcome were used as main outcome measures. Results: The two groups were comparable in age, sex, comorbidity, mode of trauma, and classification of fracture. In hemiarthroplasty, 93.3% of patients were able to start partial weight bearing on post-operative day 1, while in the internal fixation group, 75.4% of patients started partial weight bearing after two weeks post-operatively. At the final follow-up, one year after surgery, the mortality rate did not differ between the two groups, but general and mechanical complications were more common in the internal fixation group. The mean Harris Hip Score at final follow-up was better in the hemiarthroplasty group (91.14 vs 74.33). Conclusion: Primary cemented bipolar hemiarthroplasty was superior to internal fixation in terms of lower complication rates and better functional outcome. Level of evidence: Level 4

Unstable intertrochanteric fracture in elderly patients: outcome of primary cemented bipolar hemiarthroplasty versus internal fixation