Introduction: Prior literature demonstrates that in patients with blunt femoral shaft fractures, ipsilateral femoral neck fractures occur at a rate of 1-9% and can be challenging to diagnose. Ballistic fractures of the femoral shaft remain an area of ongoing research, with little evidence examining whether these fractures also carry an increased risk of ipsilateral femoral neck fracture. The purpose of this study is to evaluate the incidence of concurrent ipsilateral femoral neck and femoral shaft fractures after ballistic injuries. Methods: We performed a retrospective review of ballistic diaphyseal femur fractures treated with operative fixation in adult. Operative reports, X-ray (XR), and computed tomography (CT) images were utilized to assess for ipsilateral femoral neck fractures diagnosed at the time of injury, intra-operatively, or post-operatively. Results: The study included 77 patients who sustained ballistic fractures of the femoral diaphysis. 94% of fractures were classified as AO/OTA 32C. Two patients (2.6%) had femoral shaft fractures with direct extension into the femoral neck identified on CT imaging. No femoral neck fractures occurred independent of the site of primary femoral shaft comminution. Conclusion: Ballistic fractures of the femoral shaft carry a low risk of ipsilateral femoral neck involvement. Understanding the incidence of femoral neck involvement is a crucial component in diagnosing and treating these injuries. Level of Evidence: Level 4