[Objective] To explore the surgical techniques and clinical efficacy of reduction with a distractor and intramedullary nail- ing by small incisions for femoral subtrochanteric fractures. [Methods] From January 2018 to June 2019, 34 patients underwent closed re- duction with a distractor and intramedullary nailing by small incisions for Seinsheimer type Ⅱ~Ⅳfemoral subtrochanteric fractures. The perioperative, follow-up and imaging data were summarized. [Results] All patients were successfully operated on without vascular or nerve injury, and followed up for (20.00±3.16) months. The Harris score and range of motions (ROMs) including hip extension-flexion, and inter- nal-external rotations at the last follow-up significantly improved compared with those at 3 months postoperatively (P＜0.05) . At the last fol- low-up, all patients had achieved clinical fracture union with proper lower limb alignment. In terms of imaging, the reduction quality of frac- ture was excellent in 8 cases, good in 24 cases and poor in 2 cases, with an excellent and good rate of 94.12%. Radiographs revealed bony healing in 23.53% at 3 months after the operation, whereas 100% at latest follow-up, without loosening or fracture of the internal implants. [Conclusion] The reduction with a distractor and intramedullary nailing by small incisions for Seinsheimer type II ~ IV femoral subtrochan- teric fractures has an advantage of high surgical efficiency.