Femoral shaft fractures represent 17% of all musculoskeletal injuries in low and middle-income countries (LMICs), where they are often treated with prolonged traction for six weeks. In Malawi, as in other LMICs, surgical repair is often deemed as expensive and not cost-effective, though little evidence exists to support this notion. Therefore, the goal of this study is to determine the cost of both: traction and intramedullary nailing of femoral shaft fractures in Malawi. And to conduct a cost-effectiveness analysis of nailing vs traction.