[Objective] Meta-analysis was used to evaluate the risk factors of failure after PFNA internal fixation of femoral intertrochanteric fracture. [Methods] The related literatures of CNKI, Wanfang and Pubmed were searched and the data were extracted by computer, and the meta-analysis was carried out by ReviewManager5.3 software. [Results] A total of 14 articles were included, including 11 in English and 3 in Chinese, all of which were retrospective case-control studies. The Newcastle Ottawa scale was used to evaluate 9 articles with 8 points, 3 articles with 7 points and 2 articles with 6 points. All patients with intertrochanteric fractures were treated with PFNA internal fixation. 2477 cases failed after internal fixation. All cases were followed up for at least 6 months. The influencing factors of failure after PFNA internal fixation are fracture stability[OR=20.94,95%CI (13.45,32.61), P＜0.00001], fracture reduction quality[OR=9.68,95%CI (4.85,19.3), P＜0.00001], tip-apex distance[OR=3.98,95%CI (2.71,5.84), P＜0.00001], osteoporosis[OR=2.88,95%CI (2.01,4.15), P＜0.00001], lateral wall integrity[OR=5.40,95%CI (3.36,8.70), P＜0.00001], complication of medical diseases[OR=3.10,95%CI (1.75,5.49), P＜0.0001] and zoledronic acid[OR=0.47,95%CI (0.26,0.85), P=0.01]. [Conclusions] Fracture stability, fracture reduction quality, apical distance, osteoporosis, lateral wall integrity and associated medical diseases were risk factors for failure after PFNA internal fixation, while zoledronic acid was a protective factor.