Since May 1972, the standard treatment of femoral shaft fractures at the Western General Hospital has been the closed femoral nailing technique of Küntscher. We have found that the use of intraoperative skeletal traction eliminates the need for immediate operation, preoperative skeletal traction, or the use of a distraction apparatus to prevent preoperative shortening. By the use of a cross-pinning technique, the closed femoral nailing method has been extended to include severely comminuted fractures of the femoral shaft and fractures of the distal third of the femur, with effective control of shortening and rotatory deformity. This allows early mobilization and discharge from the hospital for patients with these difficult fractures. One hundred and twelve consecutive traumatic fractures of the femoral shaft treated in this manner united within three to six months. The clinical results in terms of early joint movement, early weight-bearing, and rapid discharge from the hospital have been excellent.