Femoral shaft fractures (FSF) occur in young adults following high-energy trauma. They may present with other life-threatening associated injuries. Their initial management should be carried out according to ATLS guidelines. In contrast, in the elderly population, these fractures result following trivial injuries due to the underlying bone fragility. The gold standard of management of femoral shaft fractures remains locked reamed intramedullary (IM) nailing. Closed and open reduction techniques for different fracture patterns have been described with successful outcomes. Herein we describe the technique of antegrade IM nailing for femoral shaft fractures.