In children, Fractures of the femoral shaft are commonly treated by various types of traction for about three weeks followed by plaster immobilization. However, this nonoperative treatment has two major drawbacks; the first being prolonged hospitalization especially in children over 10 years old, the second being inability to maintain good alignment when there is an associated head injury or multiple trauma. Between April 1990 and June 1992, 21 patients with femoral shaft fractures were treated by means of closed Ender nailing, which were indicated when the children had an associated head injury or multiple trauma. 11 cases were followed for more than 12 months and reviewed. The results were summarized as follows; 1. Ender nailings were performed in 6 children over 10 years old and 5 children with head injury or multiple trauma regardless of the patients age. 2. Ender nails were inserted through retrograde entry in all cases. 3. This procedure allowed early weight-bearing and walking, thus shortened hospital stay (average 4 weeks in patients without head injury or multiple trauma). 4. Complications developed in 2 patients; entry hole breakage and fracture site comminution in one patient, and mild knee pain in the other patient. 5. Radiologic union was obtained at 11 weeks post-surgery. 6. Authors concluded that closed Ender nailing is very useful method in the management of femoral shaft fracture in children over 10 years old or when there is associated head injury or multiple trauma regardless of patients age.