Femoral fractures are difficult to treat in the child with head or multiple injuries. Traction may fail due to spasticity and restlessness. Poor results after closed reduction have led some authors to advocate open reduction and internal fixation which facilitates overall care. Anatomical reduction with internal fixation leads to limb overgrowth. We report our experience in anatomical open reduction of femoral fracture which had head or multiple injuries or difficult to maintain traction in children at the Kang-Nam St. Mary's Hospital. The results are as follows : 1. Among the 28 cases, there were 20 cases in male and 8 cases in female. Average age was 9.4 years. 2. Plate fixation was used in 27 cases and Kuntscher Kuentscher nail was used in one case. 3. Average union period was 11.5 weeks. There was one delayed union which was completely united in 20 weeks. 4. Average overgrowth of femur was 5.2mm. The overgrowth was related with age and handedness but it was not related with fracture site. For children who have head or multiple injuries or difficult to maintain the skin traction, open reduction with plate fixation appears the most satisfactory treatment. The overgrowth of the femur after open reduction was not significant problems clinically.