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To investigate the determinants of length of stay (LOS) for patients surgically treated for femur fractures.Retrospective medical record review.Urban Level I Trauma Center.Three hundred twenty-one patients operatively treated for femur fractures between July 12, 2015 and July 12, 2016.Intramedullary nailing, open reduction internal fixation, arthroplasty, or other (percutaneous screw or multiple hardware/technique) definitive fixation of femur fracture.Hospital LOS.Median LOS was 6.43 days (range 1–76 days). Patients were divided into 2 groups: LOS ≥6 days (n = 171) and LOS <6 days (n = 150). Univariate analysis revealed several preoperative, perioperative, and postoperative factors associated with extended LOS. Multivariate analysis demonstrated frailty [odds ratio (OR), 20.58], medical complications (OR, 20.09), an upper extremity injury (OR, 9.97), an ipsilateral lower extremity injury (OR, 6.34), time to definitive fixation (OR, 2.12), time to first physical therapy visit (OR, 1.77), and Injury Severity Score (OR, 1.14) were independent predictors of LOS.By understanding the determinants of LOS for patients with femur fracture, high-risk patients can be identified and interventions can be enacted. Earlier fixation and aggressive management of medical complications may decrease patients' LOS. Patients who meet frailty criteria under the Modified Frailty Index are at a twenty-fold increased risk of staying longer than 6 days after having a femur fracture. By identifying these patients on admission, strategies can be devised to reduce their LOS and economic burden.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.