Treatment of subtrochanteric fracture remains a challenge, but evolution of strategy has allowed for reliable results with low complications. Although several fixation options exist, reamed, antegrade intramedullary nailing (IMN) has evolved as the standard of care. Cognizant effort to achieve anatomic reduction before IMN passage allows for desired outcomes. Several reduction techniques can be used to overcome the deforming forces present in the proximal femur to allow for proper IMN placement. The purpose of this article is to review the tips, tricks, and pitfalls to avoid in the treatment of subtrochanteric femur fractures with IMN.