A retrospective study was performed including only fractures involving the middle three fifths of the femoral shaft with a minimum of 2 years followup. There were 65 fractures in Group I treated with the closed technique utilizing the image intensifier. These were compared with 65 fractures treated with open reduction and nailing. Followup averaged 4 years (Group II). Group 1 had 92% satisfactory results; Group II achieved 97% satisfactory, not statistically significantly different. Our recommendations are delaying the procedure did not appear to be advantageous; excluding the fractures with segmental bicortical loss, there are limited indications for locked nails in these fractures; the decision to use a specific type of internal fixation should be based on the fracture pattern, the surgeon's experience, and the equipment available; if a closed technique is chosen, be prepared to open the fracture if a satisfactory closed reduction cannot be attained. This, in our study, did not increase the risk of reducing the functional result.