A fracture of the femur is a severe injury; it is dreaded because of its consequences to the patient as a whole. The indication for the operation therefore depends on more factors than simply the operative and technical details (see the section on Shock and Fat Embolism). Very important is the amount of blood that has been lost, which in a fracture of the femur can vary from between 500 to 3000 ml. (Clarke, 1957, Ganzoni, 1959). As to the question of fat embolism, we only wish to remind the reader that this is a special problem (Sevitt, 1962). It is important to replace blood loss as quickly as possible, aiming at a systolic pressure about 100 and pulse rate below 100. In addition Rheomacrodex (low molecular weight Dextran) can be administered in volumes of between 500 and 1500 ml. until a good microcirculation has been re-established. It is our distinct impression that as a supplement to these measures in the treatment or prevention of shock, emergency operation and energetic postoperative care have a certain prophylactic effect upon fat embolism (Knisely, 1942, Thorsen, 1950, Gelin, 1956). The reaching of a decision for surgery, especially on any patient who has been suffering from clinical shock for a long period, is thus a responsible one. Surgery should be deferred until there is an adequate peripheral circulation and restoration of blood volume, or at least until a normal hourly output of urine has been obtained. Severe brain damage may constitute a contraindication, but injuries elsewhere, as in the abdomen and thorax, need not delay surgery, though they themselves may present problems as to which area should be approached first. For example, a ruptured spleen must be removed at once, but if the condition allows, the primary treatment of the femur may be undertaken at the same operating session. This holds true also for injuries of the gut or liver.