We compared the results of traction plus subsequent casting with rigid internal fixation in a large series of adolescent femoral shaft fractures. Of 90 patients with 96 femoral shaft fractures, 49 (52 fractures) underwent rigid internal fixation, whereas 41 (44 fractures) underwent traction and subsequent casting until healing occurred. The traction and casting group had a mean hospital stay of 26 days. The operative group had a mean hospital stay of 9 days and had fewer complications than the nonoperative group. Adolescent femoral shaft fractures can be operatively treated with excellent results and a decreased complication rate. Operation results in shorter hospitalization, which has psychological, social, educational, and economic advantages over conservative treatment.