We prospectively studied the inpatient management of closed femoral shaft fractures in adults over 10 months at Ntcheu District Hospital, Malawi. Results: We had 20 patients, who stayed for an average of 46 days in hospital. The average time to apply traction was 2.3 days. The average time from admission to X-ray was 1.1 days. We recorded 11 complications: seven pinsite infections; two leg length discrepancies of >2 cm; one delayed union; and one malunion. Owing to logistics, we were unable to survey late complications. Check X-rays (available in 17/20 patients) at discharge showed satisfactory callus in 16 patients and minimal callus in one. Ten showed improved radiological position but none had external clinical deformities. We therefore feel that, despite using far from modern techniques such as acute intramedullary nailing, overall the treatment in Ntcheu produced good results. We discuss some methods that might enhance the quality of this conservative care.