Ipsilateral fractures of the femoral neck and shaft present diagnostic difficulties and complex choices as to treatment. A review of the 83 cases reported in the literature revealed that one-third of the fractures of the femoral neck were missed initially. No consistent method of treatment can be recommended on the basis of this review. Our present protocol for this double fracture is treatment with immediate internal fixation: the femoral neck fracture is given first priority and is reduced and immobilized with multiple cancellous screws, and the femoral shaft fracture is then treated with retrograde closed intramedullary Kuntscher nailing. Appropriate exceptions to the protocol exist. We reviewed the cases of 15 patients who were treated at Harborview Medical Center and University Hospital from 1971 through 1981. Our experience with the first 2 patients led to the development of our protocol, which was applied in the 13 subsequent double fractures. Two of the 15 femoral-neck fractures were missed initially. All of the fractures had united 4 months postoperatively. Of the 9 patients who were followed for 3 years or more, 2 had aseptic necrosis of the femoral head. Compared with other reports, our protocol seems to have produced somewhat better functional results.