This systematic review and meta-analysis included six randomized controlled trials comprising 1,292 patients with femoral fractures. These patients were treated with either perioperative intravenous iron infusion or placebo. Outcomes of interest included red blood cell transfusion rates, postoperative hemoglobin levels, mortality rates, length of hospital stay, infection rates, and return to home rates. The pooled results showed no statistically significant reduction in transfusion rates (p = 0.058), with only a minor increase in hemoglobin levels by day 4–7 (p = 0.024) that was not clinically significant. Other outcomes, such as mortality, length of hospital stay, and infection rates, also showed no significant differences. The study concludes that intravenous iron alone does not provide clinically significant benefits in this context, highlighting the need for further research on combination therapies.