Background: The aim of this study was to compare the clinical and functional outcomes of three surgical techniques Dynamic Hip Screw (DHS), Cemented Bipolar Hemiarthroplasty (BHA), and Proximal Femoral Nail (PFN) in the treatment of unstable intertrochanteric fractures in elderly patients.Material and Methods: This prospective comparative study was conducted at a tertiary care hospital, including 150 patients diagnosed with unstable intertrochanteric fractures (AO/OTA Type 31-A2 and 31-A3). Patients were divided into three groups (50 in each): Group A (DHS), Group B (BHA), and Group C (PFN). Standard surgical protocols were followed, and patients underwent postoperative rehabilitation and follow-up assessments at 6 weeks, 3 months, 6 months, and 12 months. Harris Hip Score (HHS) was used for functional evaluation, and complications such as infection, implant failure, nonunion, and reoperation were recorded. Results: The mean operative time was significantly longer in the BHA group (85 ± 12.3 min) compared to the DHS (65 ± 10.2 min) and PFN (50 ± 8.9 min) groups (p < 0.001). Blood loss was highest in the BHA group (450 ± 65 ml), followed by DHS (320 ± 50 ml) and PFN (280 ± 45 ml) (p < 0.001). Hospital stay was longest in the BHA group (9.1 ± 1.8 days) and shortest in the PFN group (6.5 ± 1.2 days) (p = 0.02). At 6 weeks, the HHS was highest in the BHA group (60 ± 5.9), followed by PFN (58 ± 6.2), and lowest in DHS (52 ± 6.5) (p = 0.04). At 12 months, the scores showed a marginal difference between BHA (85 ± 5.7) and PFN (84 ± 5.8), with DHS slightly lower (82 ± 5.9) (p = 0.07). Implant failure was highest in the DHS group (6%), compared to 2% in BHA and 3% in PFN (p = 0.04). Immediate full weight-bearing was achieved in 100% of BHA patients, 0% of DHS and PFN patients (p < 0.001). At 12 weeks, 100% of BHA, 95% of PFN, and 80% of DHS patients were fully weight-bearing (p = 0.02).Conclusion: BHA demonstrated superior early functional recovery and allowed immediate full weight-bearing, making it ideal for elderly osteoporotic patients. PFN provided biomechanical stability, enabling early mobilization with fewer complications, making it a preferred choice for unstable fractures. DHS, while cost-effective, had a higher failure rate and delayed weight-bearing, making it less suitable for unstable fracture patterns. PFN emerged as the most balanced option, combining early mobilization, lower failure rates, and satisfactory long-term outcomes, while BHA remains suitable for elderly patients with poor bone quality.