Background <p>Femoral nailing of unstable intertrochanteric fractures can be done in a supine position on a traction table, or in lateral decubitus. Previous randomized controlled trials (RCTs) have compared these two setup techniques reporting no major differences with no previous meta-analysis about this subject. Therefore, a meta-analysis of RCTs would be helpful in informing clinicians.</p> Methods <p>PubMed, Cochrane, Embase, and Google Scholar were searched up until July 25, 2024. Inclusion criteria consisted of English or non-English-language randomized controlled trials (RCTs) comparing lateral decubitus positioning to supine positioning on a traction table in unstable intertrochanteric fractures nailing. The studied outcomes were the reduction quality, surgery-related parameters (setup time, operative time, and fluoroscopy time), and radiographic parameters (tip-to-apex distance (TAD), and collodiaphyseal angle (CDA)).</p> Results <p>A total of 4 RCTs, which included a total of 395 patients, of whom 206 underwent nailing of their fracture in a supine position on a traction table, and 189 patients underwent nailing of their fracture in a lateral decubitus position without a traction table. We found no difference in any of the studied outcomes except for the setup time which was higher in the traction table group (mean difference 6.99 [95% CI 3.57 to 10.41]; <i>p</i> &lt; 0.001).</p> Conclusion <p>This meta-analysis revealed that supine positioning on a traction table had a longer setup time with no difference in any of the remaining assessed outcomes.</p> Level of evidence <p>Level I.</p>