We reviewed the efficacy of treatment techniques for femoral shaft fractures in our regional rural hospital setting. One hundred fifty consecutive primary femoral shaft fractures were managed at the Medical Center Hospital of Vermont during the period 1974 through 1979. The method of treatment was determined by the attending orthopedic faculty. Each case was evaluated at the time of initial hospital treatment, at 30 days postinjury, and at 1 year postinjury. Patient profiles, methods of injury, types of fracture, and associated injuries were reviewed. The choice of operative or nonoperative treatment in the first 30 days was the most important factor in the result at 1 year. Results were graded as ‘good’ if angulation was 0–5° in the A-P and/or lateral views; ‘fair’, 6–10°; and ‘poor’, > 10° or any need for supplemental surgery to achieve union. Shortening, infection, and thrombophlebitis were infrequent in this series.