The management of pediatric femoral shaft fractures gradually has evolved toward a more operative approach in the past decade. This is because of a desire for more rapid recovery and reintegration of the patients, and a recognition that prolonged immobilization can have negative effects even in children. Economic pressures also favor a treatment that does not require as prolonged a hospitalization as that required with the traditional traction method. External fixation, compression plating, and intramedullary nailing all have been advocated. A retrospective review of the experience with antegrade flexible intramedullary nailing in 25 children was performed. No nonunions or significant malunions were seen. Followup evaluation of limb lengths and proximal femoral morphology showed minor variations of articulotrochanteric distance and neck shaft angle, none of which were clinically significant. Likewise, minor limb length discrepancies were measured (range, -11- +14 mm) with no consistent pattern of overgrowth noted. There was no evidence of a complete trochanteric growth arrest on radiographic followup. Flexible intramedullary nailing seems to be a safe and effective method for the treatment of femoral shaft fractures in the child between 6 and 12 years of age.