Unstable intertrochanteric and subtrochanteric fractures in elderly patients are still a challenge in orthopedic surgery. The results of the present study show the importance of a rigid fixation to allow early mobilization and immediate weight bearing. The gamma nail has clearly brought an improvement to the treatment of such fractures, although there are complications associated to this implant which need to be reduced by further developments of the implant itself, the instruments, and/or the operative technique.