Rigid intramedullary (IM) nailing is an effective procedure for treating fractures of the femoral shaft. Despite the existence of alternative devices and techniques (eg, unreamed nails, flexible nails, plates, external fixation, and traction), the use of rigid reamed nails has shown excellent healing rates, return of function, alignment, and low complications. This type of nail has been used in an antegrade approach to the entry site of the fracture, resulting in successful treatment. We describe indications, contraindications, and surgical techniques of antegrade IM nailing associated with our personal experience and published results. We provide pearls and pitfalls to assist orthopaedic surgeons in the effective implementation of this approach. A complete understanding and awareness of the various techniques related to antegrade IM nailing can help successfully treat most femoral shaft fractures in adults.

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