New insights into fixation for intertrochanteric hip fractures highlight how device evolution has reshaped outcomes. Earlier studies raised concerns about higher revision rates with older cephalomedullary nails, but pooled data from randomized trials show that newer-generation designs no longer carry that elevated risk when compared with sliding hip screws. Across multiple timepoints, CMNs consistently produced quicker gains in mobility, with functional advantages emerging as early as 1–2 months and persisting at later follow-up, particularly with modern implants. Variation in study quality and heterogeneity limits absolute certainty, yet the overall trend suggests that improvements in implant engineering and surgical familiarity have narrowed historical gaps and may now favour CMN use for both early and longer-term recovery.