Objective To analyze and compare the clinical efficacy and influence of surgical methods, intramedullary nail fixation and open reduction and internal fixation for the treatment of femoral shaft fractures.Methods A total of 80 patients with femoral shaft fracture admitted in our department from June 2020 to June 2021 were selected as the research objects. They were randomly divided into open reduction and internal fixation group (n=40) and intramedullary nail fixation group (n=40 The occurrence of varus deformity, internal fixation failure, incision infection, and bone nonunion, the number of weeks of fracture healing during the rehabilitation treatment after discharge, and the knee joint function recovery score after 1 year of follow-up.Results For the evaluation of femoral shaft fracture healing, the use of intramedullary nail fixation resulted in shorter operation time, less intraoperative bleeding, shorter postoperative hospital stay, lower postoperative complications, higher knee function recovery score, and shorter fracture healing weeks. The difference between the two groups was statistically significant (P<0.05).Conclusion Compared with open reduction and internal fixation, intramedullary nail fixation has obvious advantages in the treatment of femoral fracture, which is worthy of extensive clinical application.