This chapter describes the fractures of the proximal femur in children. Fracture of shaft of femur accounts for 10% of the limb fractures in children. Treatment of femoral shaft fractures has evolved with advancement in implants availability, improved safe surgical techniques, social factors and the need for an early return to function. The majority of femoral shaft fractures are isolated injuries, some have associated head, chest or abdominal injuries. Neonates and infants, traction before casting, flexible intramedullary nail fixation, external fixation, rigid intramedullary nail fixation, difficult femoral fractures, open reduction and plate fixation, leg-length discrepancy, rotational malunion, delayed union and nonunion, angular deformity and compartment syndrome are the management options for femoral shaft fractures. For conservative treatment, the reduction plan must be made before manipulation based on muscle forces. Alignment of fracture must be monitored weekly for 3 weeks.