This is a review of the treatment of 12 femoral shaft fractures and three nonunions in lipomatous patients who had a greater trochanteric insertion point for intra medullary nailing. Indications included overweight patients and trochanteric lipodystrophy. Combined with a small proximal extension of the incision, maximal limb adduction, and a slotted intramedullary nail, the greater trochanteric insertion point was effective, and no complications directly related to this procedure were encountered.