Background: Femoral fractures are common in children between 2 and 12 years of age and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. We compared primary hip spica with closed reduction and fixation with crossed Rush pins for diaphyseal femur fracture in children. The hypothesis was that Rush pin might provide better treatment with good clinical results in comparison with primary hip spica.

Materials and Methods: Fifty children with femoral fractures were evaluated; 25 of them underwent conservative treatment using immediate hip spica (group A) and 25 were treated with crossed retrograde Rush pins (group B). The patients ages ranged from 3 to 15 years (mean of 9 years).

Results: Mean duration of fracture union was 16 weeks in group A and 12 weeks in group B. Mean duration of weight bearing15 weeks in group A and 8 weeks in group B. Mean hospital stay was 5 days in group A and 9 days in group B. Mean follow up period in group A was 16 months and group B was 17 months. Complications such as angulation, shortening, infection were compared.

Conclusions: Closed reduction and internal fixation with crossed Rush pins was superior in terms of early weight bearing and restoration of normal anatomy.