Between 1992 and 1996, 73 acute humeral shaft fractures in 71 patients were treated with antegrade Russell-Taylor humeral nailing. Sixty (84%) patients sustained multiple trauma, and 26 (36%) fractures were open. Three patients had preoperative brachial artery injuries, and 12 had preoperative nerve palsies. Sixty-nine (94.5%) fractures united primarily, and two additional fractures united after bone grafting. There were no infections. Two (2.7%) iatrogenic radial nerve palsies occurred, and both were transient. Full shoulder function returned in 66 (90%) patients. Two (2.7%) patients had impingement from proximal locking screws, and one (1.4%) had impingement from a prominent nail. Normal elbow function was regained in 96% of patients. All patients without full return of elbow and shoulder function had concomitant injuries. Antegrade Russell-Taylor nailing is an acceptable alternative for the treatment of acute humeral shaft fractures in multiply injured patients.