Seven randomized controlled trials including 658 patients with intertrochanteric femur fractures were included in this systematic review and meta-analysis comparing short versus long cephalomedullary nails (CMN). Pooled outcomes of interest included Harris hip score, 1-year mortality, overall complication rates, reoperation rates, duration of surgery, intraoperative blood loss, tip-apex distance, and hospital stay length. The pooled results showed no significant differences in Harris hip score, mortality, complications, or reoperations. However, short nails were associated with shorter surgery time, lower blood loss, and reduced tip-apex distace. These findings suggest short nails may offer intraoperative efficiency benefits without compromising safety or functional outcomes.