Aims: Published series of traditional plate þxation of the femur note rates of up to 69% primary bone grafting, 13% infection, 15% nonunion, 68% late complications, and 25% secondary surgical procedures. A shift from traditional plating to submuscular plating has thus ensued. This series entails an all-inclusive review of the plate þxation experience by two orthopaedic trauma surgeons in a þve-year period at a university trauma center. Methods: Between June 1996 and May 2001, 40 acute diaphyseal femoral fractures in 37 patients were managed utilizing dynamic compression plating via traditional Ç biological È plating with a formal lateral incision (n = 19), or submuscular plate þxation utilizing only a proximal and distal incision (n = 21). A comparison of reduction quality, union rates, and infection rates between traditional plate þxation and submuscular þxation was performed. Results: Thirty-nine of forty femoral shaft fractures healed without need of a secondary procedure. One nonunion occurred in the ORIF group. There was one infection in each group. Two patients treated by submuscular þxation developed signiþcant heterotopic ossiþcation around the femoral shaft which signiþcantly impaired knee motion. There were 6 cases of malreduction in the submuscular group, and none in the ORIF Group. Conclusions: Although the theoretical advantages of submuscular plating are well established, its utilization in the femoral shaft did not have a clear clinical advantage. In addition, its use appears to be more technically challenging, and is associated with a high rate of sub-optimal reductions.