Objective    To investigate the efficacy of utilizing a self-designed and developed three-dimensional closed reduction device for femoral shaft fracture in closed reduction and antegrade intramedullary nailing.    Methods    From July, 2019 to June, 2021, 68 patients with femoral shaft fractures were treated with a self-developed three-dimensional closed reduction device for antegrade intramedullary nail fixation during operation, including 46 males and 22 females, aged from 18 to 75 years, with an average of 35.8 years. According to A0 classification, there were 35 cases of type 32a, 22 cases of type 32B and 11 cases of type 32c. The interval from injury to operation was 4~12 days, with an average of 6 days. The operation duration, intraoperative blood loss, time spent on fracture reduction and time taken to achieve healing were evaluated.     Results    The operation duration was 80~130 minutes, with an average of 95 minutes. The intraoperative bleeding volume was 100~200 ml, with an average of 160 ml. The time spent on fracture reduction was 5~30 min, with an average of 20min. 68 cases were followed up for 6~24 months (averaging 13.5 months). All fractures healed, and the time taken to achieve healing was 4.0~10.5 months, with an average of 6.0 months. No iatrogenic fracture, infection, neurovascular injury, nail breakage and other complications occurred.    Conclusions    The three-dimensional closed reduction device for femoral shaft fracture is easy to operate, can effectively assist the closed reduction of femoral shaft fracture, maintain the fracture reduction for intramedullary nail internal fixation.