Background <p>Globally, physical injuries are the leading causes of disability-adjusted life years (DALYs), morbidity, and mortality, and account for nearly four and a half million lives lost per year, approximately 8% of the world’s annual deaths. In Uganda, physical injuries cause substantial public health problems that have reached epidemic proportions, with Boda-boda accidents being the leading cause. This study aimed to describe femur fractures, the characteristics of patients, treatment outcomes, and factors associated with good outcomes at Gulu Regional Referral Hospital in Uganda.</p> Materials and methods <p>An IRB-approved retrospective review of patients 18 years and above who sustained femur fractures and were treated at Gulu Hospital’s Department of Surgery in 2022 was conducted. A systematic sampling of patients’ files from records in the Surgery Department was done. Two groups of patients were classified based on whether operative or non-operative methods were used for femur fracture management. The study’s primary outcomes were the characteristics of the patients, factors associated with femur fractures, and good treatment outcomes at discharge. A multivariate regression analysis was conducted to determine factors associated with femur fracture and status at discharge. A p-value &lt; 0.05 was considered significant at 95% Confidence Intervals.</p> Results <p>One hundred and fifty-four femur fracture patients’ files were selected. Most were males, 58.8% (<i>n</i> = 91); 18–30 years, 24.8% (<i>n</i> = 38); fractures resulting from road traffic crashes, 63.0%(<i>n</i> = 96), and passengers, 60.6% (<i>n</i> = 60); with femur shaft fractures, 35.2% (<i>n</i> = 55); of transverse fracture lines, 36.4% (<i>n</i> = 56) and closed fractures, 88.4% (<i>n</i> = 134). At multivariate regression analyses, factors associated with femur fractures were: age-groups 61–75 years (adjusted Odds Ratio (aOR) = 13.9, 95%CI: 1.68–114.09; <i>p</i> = 0.015); &gt;75years (aOR = 2.50, 95%CI: 1.22–4.95; <i>p</i> = 0.012); and diploma/degree holders (aOR = 5.01,95%CI:1.03–15.68;<i>p</i> = 0.046). Factors associated with improved status at discharge were: occupations (aOR = 4.02, 95%CI:1.52–10.63; <i>p</i> = 0.005); open reduction, (aOR = 11.15, 95%CI: 2.18–44.28; <i>p</i> = 0.001); oblique fracture lines (aOR = 4.95, 95%CI: 1.62–15.12; <i>p</i> &lt; 0.000); spiral fracture lines (aOR = 5.50, 95%CI: 1.71–17.90; <i>p</i> = 0.004); and transverse fracture lines (aOR = 4.34, 95%CI:1.68–11.23; <i>p</i> = 0.002). It was less likely for open femur fracture patients to be discharged, improved (aOR = 0.13, 95% CI:0.05–0.360; <i>p</i> &lt; 0.000).</p> Conclusion <p>Femur fracture is an important surgical and public health problem among GRRH patients. It is associated with older age groups and educational levels. Factors associated with improved status at discharge were occupations (peasant farmers and persons employed in the informal sectors), open reduction, spiral, transverse, and oblique fracture lines. Improved status at discharge was less likely in patients with open fractures. We recommend more strategies to reduce the incidence and prevalence of femur fractures by designing and reinforcing policies that reduce motor vehicle accidents in the region. In addition, more efforts should be made to supply enough implants for the management of fracture patients using open reduction and internal fixation.</p>