The results of open nailing in 14 cases of neglected closed femoral shaft fractures were reviewed. The mean patient's age was 28 years (range, 17-50). The mean delay to definitive treatment was 4.6 months (range 2-10). All fractures were malaligned with an average shortening of 4.9 cm (range 2.5-6.5). All cases underwent one-stage open nailing using the Küntscher nail fixation. The femur was shortened at the fractured end of one or both fragments to accomplish reduction in nine cases. The mean length of the bone resected was 9 mm (range 5-15). Only local callus was used for bone grafting in all cases. There were no neurovascular complications. All fractures healed an average of 3 months (range 2-4) after operation. Six cases had regained full knee flexion at the time of the latest follow up. Eight cases had decreased knee flexion with an average arc of knee flexion of 119 degrees (range, 100-125). The mean length of hospital stay was 7 days (range, 5-12). The method was found to be safe and effective with acceptable shortening and knee motion.