Four randomized controlled trials including 395 patients with unstable intertrochanteric fractures were included in this meta-analysis comparing lateral decubitus positioning without a traction table (189 patients) versus supine positioning on a traction table (206 patients). Pooled outcomes of interest were reduction quality, setup time, operative time, fluoroscopy time, tip-to-apex distance (TAD), and collodiaphyseal angle (CDA). Results showed no significant differences between groups for reduction quality, surgical time, fluoroscopy time, TAD, or CDA. The only significant difference was a longer setup time in the traction table group. Overall, lateral decubitus positioning appears to be a safe and efficient alternative to traction table use, with the added benefit of shorter setup time.