Intramedullary nailing is an effective treatment of femoral shaft fractures. However, this procedure has several common complications and technical problems that can interfere with full recovery in some patients. The purpose of this review article is to expand on the literature with the authors’ own experiences to summarize the following common complications of femoral nailing: missed injuries, suboptimal surgical timing, malreduction, reaming errors, implant insertion errors, pain-management problems, and implant removal errors. Strategies are also identified to help avoid and manage these complications.

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