Femoral shaft fractures occur in a bimodal distribution, resulting from high energy trauma in young patients and lower energy mechanisms in older patients. In cases of high energy trauma, the orthopedic surgeon must have a high suspicion for associated injuries, some of which may be subtle due to the distracting nature of the femur fracture. Femoral shaft fractures can be temporized in the preoperative period with the use of skeletal traction, which fatigues the thigh musculature and relieves muscle spasm. Typically, intramedullary nailing is used as definitive treatment, while open reduction and internal fixation or external fixation may be used in select cases.