Forty-nine patients with femoral shaft fractures were randomized to receive either greater trochanter (GT) entry nailing (n=24) or piriformis entry (PE) nailing (n=25). The primary outcome of interest was the drop in hemoglobin levels, and the secondary outcomes included surgical time, fluoroscopy exposure, functional outcomes (measured by the Modified Harris Hip Score), radiological healing, and signs of avascular necrosis (AVN). Outcomes were assessed up to 6 months. Overall, the results revealed that the GT group experienced significantly less intraoperative blood loss (p = 0.025) and showed better early functional outcomes at 4 weeks post-op (p = 0.012). However, there were no significant differences between the two groups in the long-term functional and radiological outcomes. These findings suggest that both entry points are effective, though GT may offer certain early postoperative advantages.