Outcomes of pediatric femoral fractures treated with traction followed by cast (conservative treatment) were compared with flexible nailing treatment. Fifty-one femoral fractures (24 conservative, 27 nail) from 46 patients were studied retrospectively. Four cases of angular deformities greater than 10 degree were observed from the conservative treatment and none from the nailing group. Conservative treatment showed a wider variance of leg length discrepancy (LLD) and four cases showed severe LLD greater than 10 mm. The nailing group had no discrepancy. Retrograde flexible nailing may result in more reliable outcomes than conservative treatment for femoral fractures.