68 patients with femoral shaft fractures were randomized to receive either intramedullary nail (IMN) fixation with or without a fracture reduction and guidewire-aiming device. The purpose of this study was to determine if the use of a novel fracture reduction and guide wire aiming instrument was able to improve the operative efficiency of femoral fracture fixation. Findings indicated that a newly designed and manufactured instrument significantly improved the operative time, and decreased the frequency of wire drilling as well as the number of cases requiring open reduction when compared to IMN fixation without the device.