The Modny transfixion intramedullary nail has been used in 261 cases of complex femoral fractures with excellent results. Proximal, medial, and distal comminutions of all sizes were accurately transfixed by this open method. Transfixion screws and biologic ingrowth fixed the fragments rapidly, resulting in no measurable shortening or rotational deformity, and rapidity of healing was enhanced. The nail was also used in five knee fusions.