[Objective] To compare the clinical efficacy between distal locked and unlocked intramedullary nailing in the treatment of Intertrochanteric fracture by using Meta analysis. [Method] The data bases, such as China National Knowledge Infrastructure（CNKI），Wanfang database，VIP database ,China Biological Literature system(CBM), PubMed, Embase, and Cochrane library were searched for the comparison of clinical outcomes of distal locked versus unlocked intramedullary nailing in the treatment of Intertrochanteric fracture from the creating to October 2022. Literature screening, quality assessment, and data extraction were conducted to meet the inclusion and exclusion criteria. Rev-Man 5.3 was used to perform the meta-analysis of parameters related to the consequences. [Results] A total of 9 studies were included, involving 1977 patients with intertrochanteric fractures were treated with intramedullary nail fixation (830 in the distal locking group and 1147 in the distal unlocking group). The results of the Meta-analysis showed that the intraoperative parameters of unlocked group, such as operation time, intraoperative bleeding, fluoroscopy time, total incision length were better than those of locked group, The difference was statistically significant(P<0.05). Among the postoperative complications, the incidence of postoperative thigh pain in the distal unlocking group was lower than that in the locking group (P< 0.05). There was no significant difference in complications such as delayed fracture healing, hip pain, wound infection, screw cutting, peri-implant fractures (P> 0.05). In terms of postoperative function, there was no significant difference in HHS score between the two groups at the last follow-up (P> 0.05). [Conclusion] For intertrochanteric fractures (31A1+A2), distal locking of the head pulp nail is not necessary, and distal non locking treatment can be selected.