Intertrochanteric femur fractures remain an important global health concern with rising numbers with an aging population. Determining the stability of the fracture is essential to choosing the appropriate implant for fixation of these fractures. To achieve a successful outcome, surgeons must consider the fracture pattern and choose a technique to obtain the reduction and an implant that will maintain reduction until bony union. This review examines how to determine the stability of intertrochanteric fractures and choose the optimal implant. In addition, we suggest technical tips for reduction and implant placement to reduce the risk of implant failure.