The surgical technique of ante-grade femoral nailing utilizing intraoperative ultrasound to assist with the accurate three-dimensional localisation of the proximal entry point is demonstrated. Adjunctive intraoperative ultrasound in the management of femoral fractures is easy to conduct, reduces operative time and assists with accurate percutaneous internal fixation in complex fracture patterns. Intraoperative ultrasound is particularly useful in the management of obese patients and in fractures of the proximal femur where significant deformity is present.