The last 20 years have seen a great deal of controversy about the indications for and the timing of operative fracture treatment in multiply injured patients. In central Europe a standardized concept of treatment has been widely adopted since the late 1970s. In this concept a few types of fractures are given a high priority and are operated on early. Most fracture types, however, are not stabilized by internal fixation until several days after the injury. The treatment of closed femoral shaft fractures is still hotly debated. So far, not a single prospective study proving the advantages or disadvantages of early fixation has been published.