BACKGROUND: A variety of implant devices have been used for treatment of intertrochanteric femoral fractures (IFF), but the optimal has long been disputed. We aim to summarize the latest evidence for the effectiveness and safety of implants for IFF. METHODS: This systematic review and network meta-analysis included searches of PubMed, Embase, the Cochrane Library, and Web of Science from January 1, 2000 to August 31, 2024, for randomized controlled trials of implants in older adult patients with intertrochanteric femoral fracture. Non-English studies, pathological fractures, pathological reports, animal studies, conference abstracts, and incomplete primary were deemed ineligible. We performed frequentist random-effect network meta-analyses to summarize the evidence and applied the Confidence in Network Meta-Analysis frameworks to rate the certainty of evidence, calculate the treatment effects, categorize interventions, and present the findings. The study was registered with PROSPERO, CRD 42,024,562,020. RESULTS: A total of 54 eligible trials were identified, involving 15 implants and enrolling 10,275 participants; all subsequent estimates refer to the comparison with sliding hip screw (SHS). InterTAN nail (ITN) resulted in the largest reduction in non-mechanical major post-surgery complications (OR, 0.55; 95% CI, 0.33 to 0.91; moderate confidence). No significant differences were found in terms of Harris hip score, reoperation rate, and overall mechanical complications with moderate to low-level evidence. In secondary findings, percutaneous compression plate (PCCP) resulted in the lowest occurrence of non-mechanical minor post-surgery complications (OR, 0.12; 95% CI, 0.05 to 0.30; high confidence), and proximal femoral nail anti-rotating (PFNA) (OR, 0.05; 95% CI, 0.02 to 0.11; high confidence) resulted in most reduced non-specific mechanical complications, respectively and. ITN demonstrated the highest risk of operative issues (OR, 3.41; 95% CI, 2.03 to 5.73; moderate confidence). CONCLUSIONS: In older patients with intertrochanteric fractures, ITN proved among the most effective in reducing non-mechanical major post-surgery complications, but had the highest risk of intraoperative complications. No implants demonstrated superior effectiveness over others. REGISTRATION OF SYSTEMATIC REVIEWS: CRD 42021245678, PROSPERO.