This study was aimed at comparing the osseointegration of titanium (Ti)-based Kuntscher nails (K-nails) and plates with modified nanostructured and hydroxyapatite-coated surfaces in a rat femur model. Material surfaces were first modified via a simple anodization protocol in which the materials were treated in hydrogen fluoride (1% w/w) at 20 V. This modification resulted in tubular titanium oxide nanostructures of 40-65 nm in diameter. Then, hydroxyapatite-deposited layers, formed of particles (1-5) m, were produced via incubation in a simulated body fluid, followed by annealing at 500 degrees C. Both surface modifications significantly improved cell proliferation and alkaline phosphatase (ALP) activity as compared to the control (non-modified Ti implants). The controls and modified nails and plates were implanted in the femur of 21 male Sprague-Dawley rats.The implants, with surrounding tissues, were removed after 10 weeks, and then mechanical tests (torque and pull-out) were performed, which showed that the modified K-nails exhibited significantly better osseointegration than the controls. Histologic examinations of the explants containing plates showed similar results, and the modified plates exhibited significantly better osseointegration than the controls. Surface nanostructuring of commercially available titanium-based implants by a very simple method - anodization - seems to be a viable method for increasing osseointegration without the use of bioactive surface coatings such as hydroxyapatite.