Introduction: A malunion can be defined as the consolidation of a fracture site with structural alteration of the bone, affecting its configuration, length, and alignment.

The objective of our study was to evaluate the results of surgical treatment of diaphyseal malunions of the femur in our department.

Patients and Methods: This was a retrospective, single-center, descriptive study covering an 8-year period from January 1, 2017, to December 31, 2024, involving 23 patients admitted to Donka University Hospital for malunions of the femoral shaft, with or without other complications.

Results: The average time to treatment was 6 months (ranging from 3 to 16 months). We performed osteotomy with screw fixation in 56.5% of cases and static locked intramedullary nailing in 43.5%. Cortico-cancellous bone grafting was performed in 26.1% of cases. The average length of hospital stay was 7 days (ranging from 3 to 30 days). Our functional results were good in 8 cases (34.8%), average in 11 cases (47.8%), and poor in 4 cases (17.4%). The average postoperative knee flexion was 120° (ranging from 60° to 130°). The average limb length gain was 2 cm (ranging from 1.5 cm to 4.5 cm). At the 6-month follow-up, we noted 2 cases of aseptic pseudoarthrosis.

Conclusion: Diaphyseal femoral fractures should be treated surgically, preferably with locked intramedullary nailing, to avoid the development of malunions, whose functional prognosis is dominated by stiffness, axial defects, and lameness.