Diaphyseal fractures of the femur in pediatric patients have a bimodal presentation, being associated, between 2 and 4 years of age, with falls, and then, during adolescence, with high-energy trauma. They represent a therapeutic challenge for the doctor. There being a wide range of therapeutic options, depending on the age and weight of the patient, the characteristics of the fracture and its context. These options include conservative and surgical treatment, which may require the use of osteosynthesis including an external fixator, stable elastic intramedullary nailing, lateral trochanteric entry rigid intramedullary nail, or submuscular plate.