Early fracture fixation in the multiply injured patient has been shown to reduce morbidity and mortality. This premise recently has been questioned when the multiply injured patient has a pulmonary contusion, and also has a femoral fracture stabilized with a reamed intramedullary nail. This put into question whether early stabilization of femoral fractures, especially with a reamed intramedullary nail, should be performed in patients with a pulmonary contusion. A review of the most recent clinical and animal research was performed to help answer this question. This review has revealed that the incidence of pulmonary failure and adult respiratory distress syndrome in multiply injured patients with thoracic injuries who have femoral fractures treated acutely is less than 3%. The morbidity associated with patients with pulmonary contusions is independent of the treatment of the femoral fracture. No difference in the rate of pulmonary failure is found with reamed nails or plate fixation. The pulmonary failure seems to be secondary to the pulmonary contusion, not to the method of fracture fixation.