The management of neglected femoral shaft fractures poses a challenge to the orthopaedic surgeon. We evaluated the outcome of open intramedullary nailing of neglected femoral shaft fractures at our centre. A total of 52 patients with 55 femoral shaft fractures, with a mean age of 39.6 years, were studied. The mean interval from injury to presentation was 24 weeks (range = 4-156). Mean time to achieve fracture union was 20 weeks (range: 14-48). The time to fracture union and weight bearing had a positive correlation with the time interval between injury and fracture fixation, development of deep wound infection and osteomyelitis. There is a need to make orthopaedic and trauma care accessible to underserved communities to avoid the adverse outcome of neglected fractures.