The use of a closed nailing technique for elderly patients with intertrochanteric fractures has resulted in a substantially improved mortality. The incidence of fixation failures and degree of shortening are similar to that experienced with sliding screw and sliding nail plate systems. However, since rotational deformities may occur, the procedure is most beneficial for debilitated patients with intertrochanteric fractures, who represent substantial surgical risks. In general, subtrochanteric fractures occur in a younger group of patients. Since the proximal fragment is usually much larger and the quality of bone superior in this group of patients, the fixation failure rate was extremely low and significant loss of rotatory reduction did not occur. The body of experience gained in recent years with closed nailing techniques for femoral shaft and tibial fractures is directly applicable to the closed nailing of intertrochanteric and subtrochanteric fractures. Extremely comminuted fractures or long oblique fractures may shorten, and rotatory reduction and control must always be a concern. These difficulties must be weighed against the advantages of a negligible infection rate and extremely low nonunion and implant failure rates.