Fractures in the subtrochanteric zone of the proximal femur present complex treatment challenges. These treatment difficulties are related to the anatomic and biomechanic features that are unique to this area. These fractures occur in older patients from low-energy trauma and in younger patients with high-energy trauma, with separate diagnostic and treatment significance. Intramedullary fixation with standard centromedullary nails, as well as cephalomedullary nails, are commonly employed as fixation methods to treat this fracture. The techniques and results of this will be reviewed.