Concomitant ipsilateral shaft and femoral neck or pertrochanteric fractures are uncommon. They result from high-energy traumas and the mechanism of injury is usually complex. The proximal fracture is often not displaced and may be hardly visible on x-rays. Overlooking the proximal fracture may result in therapeutic problems. The best method of treatment is by closed stabilization of both fractures with a reconstruction nail. In our opinion, concomitant neck and femoral shaft fractures demand particular alertness in x-ray analysis, precision in fracture stabilization and usually longer patient rehabilitation.