Summary: Intramedullary (IM) nailing of subtrochanteric femur fractures, although commonly performed, has many associated technical challenges. Most of these relate directly, or indirectly, to the starting point. Apex anterior and varus malreductions as well as intraoperative comminution at the fracture site are examples of non-ideal outcomes related to the starting point. These can be minimized by obtaining the proper starting point location and starting trajectory. Multiple factors must be accounted for, such as variations in individual anatomy and the unique properties of the selected implant, in order to define the proper starting point. This article will review the technical subtitles for obtaining an ideal starting point and discuss how common problems can be avoided.