This is a retrospective analysis of 56 children under the age of 16 years who had femoral shaft fractures and were treated at the Asir Central Hospital by open reduction and internal fixation. The age range was 5-16 years (average 10.8 years). Two patients had bilateral femoral shaft fractures. Female-male ratio was 1:5.2. The two legs were almost equally affected. The most common area of fracture location was the mid-diaphyseal region, 35 cases (60.3%) and the most common type of fracture seen was closed transverse, 22 cases (37.9%). The most common cause of injury was motor vehicle accident, 36 cases (64.3%) and the most common associated injury was head injury, 28 cases (48.3%). A plate was most commonly used for internal fixation, 44 cases (75.9%). The most common immediate post-operative complication was bleeding, 25 cases (43.1%) and the most common late complication was knee joint stiffness, three cases (5.2%). Hospital stay ranged between 7 and 48 days (average 25.9 days). The most common causes of prolonged hospital stay were the associated injuries with the fractured femur. Of the total 58 femoral shaft fractures, there was one case (1.7%) of non-union, and of the 56 patients in this series one (1.8%) died. It is concluded that open reduction and internal fixation of femoral shaft fractures is a good modality of treatment in children in our environment.