We made a revision of the literature for the role that has today the orthopedic treatment in the femur fractures in children. We discuss the alternatives of treatment, advantages and disadvantages of each one, and the precise indications. In general the non surgical treatment is recommended in the children smaller than 6 years. There are some precise indications for the use of immediate spica cast. In bigger than 14 years the surgical treatment is recommended. The group among the 6 to 14 years has more controversies about the best treatment. There are many factors like the age, the patient physical appearance, type and localization of the fracture, and socioeconomic factors to take a good decision.