Abstract Intramedullary nailing is the treatment of choice for fractures of the femoral shaft. Newer nail designs have allowed the orthopaedic surgeon to use a more “implant specific” approach to treating these fractures. Antegrade nailing is efficacious for the treatment of subtrochanteric and femoral diaphyseal fractures. Retrograde nailing has been shown to be equally effective in the treatment of fractures of the femoral shaft and very advantageous for distal one-third and supracondylar fractures. In addition, retrograde femoral nailing has been able to improve he treatment of femoral shaft fractures associated with other combined musculoskeletal injuries, The surgical technique although straightforward may be greatly improved by the understanding of the subtleties of this procedure.