Bilateral femur fractures are uncommon in the adult population with most of the patients presenting with or develop features of Fat embolism in early stages. The treating team including Emergency physician,Surgeon and Intensivist and Anaesthesiologist are often in a dilemma about appropriate management of these patients.The purpose of this study was to review our institutional experience with a study of simultaneous bilateral femur fractures with evolving symptoms of fat embolism and to highlight the presentation, treatment, and outcomes of these injuries , in order to identify any clinically relevant differences that may guide future management. Our study also helps us to guide for early intervention with damage control nailing with smaller diameter nail instead of waiting for the symptoms of fat embolism to wean off.