Marrow nailing developed by Gerhard Küntscher for long tubular bones is an excellent surgical procedure for fractures of the lower leg shaft. It yields outstanding results both with the typical good indications in respect of shape of fracture, localisation and soft tissue conditions and even with atypical borderline and emergency indications where the healing results can be said to be good and satisfactory. Of course long-standing experience is required especially when employing the Küntscher intramedullary nail in the atypical range of indications. This method produces good results even in critical situations if appropriate accompanying measures are taken. Technique, results and complications are described in this article reflecting the experience of 19 years of working with the intramedullary Küntscher nail.