It appears that unreamed nailing is significantly faster (operative time) with less blood loss compared with unreamed nailing in the treatment of femoral shaft fractures; however, reamed nailing contributes to faster union times and fewer delayed unions. Neither appears to significantly increase the risk of other complications including pulmonary compromise. Functional outcomes cannot be determined.

There is some evidence to suggest superior results of surgical treatment that includes open reduction internal fixation (ORIF) or percutaneous pin fixation (not including Kapandji pinning) to stabilize fracture fragments and improve functional ability compared with conservative treatment. However, larger studies with longer follow-up are needed to verify these results.