Subtrochanteric femur fractures are complex injuries that present many challenges to the treating orthopedic surgeon. There are a variety of treatment options to take into consideration in the surgical management of subtrochanteric femur fractures. Patient positioning and implant selection are important factors to consider. The use of lateral positioning with manual traction for intramedullary nail fixation has many advantages specific to the treatment of subtrochanteric fractures. Access to the nail starting site is improved, closed fracture reduction is more easily obtained, and treatment of obese patients is facilitated. This article describes the use of lateral positioning with manual traction for intramedullary nail treatment of subtrochanteric femur fractures, including the technique, as well as its benefits and drawbacks.