Surgical treatment for long-bone fractures may require medical devices such as pins/plates, external fixators or intramedullary nails (IMN). The utilization of each type of device by fracture anatomy and patient presentation is characterized in this study. A retrospective database analysis was conducted in the IBM® MarketScan® Commercial Database. Patients with femoral, tibial or humeral fractures coded during an inpatient admission between 2008-2017 were identified. Patient demographics, comorbidities at time of index repair procedure (31 Elixhauser comorbidity indices), fracture type (open vs closed), precise fracture anatomy and repair procedure (IMN vs plating vs external fixation vs no device) were queried. The prevalence and patient/fracture characteristics associated with each repair procedure were analyzed. 165,554 patients were identified with 37,653 humerus, 58,790 tibial and 69,111 femoral fractures, of which 67%, 86% and 69% required surgical repair procedures, respectively. Within the surgical cohort, IMN was used for 46% femoral, 30% tibial and 5% humeral fracture repairs. For patients with femoral fractures, there was a significant association in use of IMN with shaft fractures (55.3% of IMN cohort vs 24.0% of the non-IMN cohort), trochanteric fractures (48.7% IMN vs 21.7% non-IMN) and displaced fractures (15.2% IMN vs 7.4% non-IMN). For patients with tibial fractures, there was also a significant association in use of IMN with open (31.5% IMN vs 17.5% non-IMN) and shaft fractures (94.5% IMN vs 32.7% non-IMN). For humeral fractures, shaft and displaced fractures were mostly associated with use of IMN. Use of IMN increased for all anatomies in the 10-years considered, from 6.0-7.3%, 28.3%-29.3% and 44.5%-56.4% for humeral, tibial and femur fractures requiring surgery. A significant proportion of long bone fractures require surgical repair. In the past 10 years, utilization of IMN for these fractures increased consistently and now represent the predominant device used for specific fractures such as shaft fractures.