The Grosse-Kempf nail is a versatile interlocking intramedullary nail with proximal and distal locking. The locking transfixion screws afford additional axial and rotational stability and have expanded the use of intramedullary fixation to include all types of femoral fractures distal to the lesser trochanter and to within 7 cm of the knee joint. Forty consecutive femoral shaft fractures treated by this method have been reviewed. Solid union occurred in 39 cases at six months from surgery. Complications were directly related to technical difficulties and fracture personality. The surgical technique is demanding and requires special expertise training and equipment, but the benefits to the patient are so great that this is now regarded as the method of choice for treating femoral shaft fractures in adults.