At present, the treatment of femoral intertrochanteric fractures in the elderly has become the mainstream surgical method. There are set screws in the proximal end of the nail, except the proximal femoral nail antirotation-Ⅱ (PFNA-II). The initial role of the set screw is to prevent the rotation of the implant in the head-neck fragment. It is still controversial in clinical practice whether to tighten the set screw to eliminate slippage during surgery, thereby preventing complications such as screw retraction and shortening of the femoral neck. This article summarizes and analyzes the history, types, clinical applications and use disputes of the set screws by referring to the literature and the manuals of various cephalomedullary nails, in order to obtain a consensus on the use of set screws and provide a reference for improving the efficacy of intertrochanteric fracture fixation.