A retrospective study of 46 femoral shaft fractures treated with A.O. compression plating by eight surgeons of varying expertise in A.O. techniques at two large trauma hospitals was undertaken. Information was gained from hospital and office records, X-rays, operative summaries, and personal interview and examination. Average followup was 3 years. There was a 24% complication rate including failure of plates and screws, refracture after plate removal, fracture near the end of the plates, nonunion, and infection. Average time to union was 7 months. Despite less than optimal surgical technique, excellent or good results were obtained in 88% of all patients and 100% of those patients who did not have complications.Conclusions1) This is an acceptable method of treating femoral shaft fractures which are not amenable to I.M. nailing providing: the A.O. techniques are strictly adhered to; bone grafts are used when there is loss of bone, less than anatomic reduction and rigid internal fixation, and or devascularized bone; the patient is followed with partial weight bearing and cast brace if necessary until healed; plate is left in situ 1 year following union; and 2) all surgeons using the A.O. technique should be aware of the necessity of anatomic reduction and rigid internal fixation, and trained in its use.