Fractures of the femoral shaft represent a large spectrum of injuries in orthopedic trauma. These fractures are most often associated with high-energy mechanisms in the young; however, there is bimodal distribution like most other fractures. In this chapter we explore the generalized principles of the anatomy relevant to operative treatment of femoral shaft fractures. We explore the surgical pitfalls that one may encounter for operative management and explore techniques to aid attaining the desired result of healed and anatomic (as possible) femoral shaft.