The authors describe a technique of Kuntscher intramedullary nailing combined with screws driven through the bone and the nail above and below the fracture site. This technique gives better stability of the fracture and allows extension of intramedullary nailing to severely comminuted fractures, fractures with loss of bone and to proximal or distal fractures. Risks of rotational instability or shortening are diminished. The technique is fully described. With the use of correct ancillary instruments, x-ray exposure is minimal. Biomechanical experiments conducted to determine the best position of the screws for optimal locking of the nail are described. The results obtained in one hundred and sixteen cases are analysed. The technique was also used in the treatment of non-union and in the fixation of osteotomies.