Objective:To examine the impact of instituting a dedicated orthopaedic trauma operating room (DOTOR) at a Level I trauma center on diaphyseal femur fracture management.Design:Retrospective cohort study.Setting:Regional, university-based Level I trauma center.Patients:Trauma patients 18–65 years of age who presented between October 2016 and December 2018 (approximately 1 year before and after implementation of the DOTOR) and underwent surgery for diaphyseal femur fractures. One hundred twenty-eight patients met eligibility criteria for inclusion: 60 were treated before and 68 after implementation of the DOTOR.Intervention:Implementation of a DOTOR in October 2017.Main Outcome Measures:Percentage of external fixation versus intramedullary nailing, time from emergency department visit to definitive fixation, duration of surgery, and hospital length of stay.Results:The only significant difference in patient demographics between the before and after groups was mechanism of injury (P = 0.003). Percentage of external fixators as an initial procedure decreased from 15% to 2.9% (P = 0.024). Time to definitive fixation with intramedullary nail decreased from 1083 minutes to 659 minutes (P = 0.002). There was no significant change in median operative time of intramedullary nailing (P = 0.573). Although not statistically significant, hospital length of stay decreased from 7 days to 5.5 days after implementation (P = 0.158). Cost analysis revealed annual cost savings of more than $261,678 for diaphyseal femur fractures alone by implementing a DOTOR.Conclusions:For diaphyseal femur fractures, instituting a DOTOR at a Level I trauma center reduced the percentage of patients requiring a 2-stage fixation, reduced the time to definitive fixation, and yielded cost savings.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.