Summary:Unreamed intramedullary nailing of tibial and femoral fractures can achieve union rates comparable to those of other techniques, including reamed nailing, and may avoid some of the potential hazards of reamed nailing, such as infection, disruption of the endosteal blood supply, and increased risk of pulmonary emboli. Operative time, fluoroscopy time, and blood loss also are decreased. However, the unreamed technique requires the use of smaller implants, and the possibility of hardware failure should be considered. Careful attention to operative technique is mandatory to prevent angular and rotational deformities. Secondary procedures, such as dynamization and exchange nailing, should be carefully planned if delayed union occurs.