Background: Paediatric femoral shaft fractures are a significant orthopaedics challenge, particularly in children aged 6–12 years, where treatment must balance anatomical healing with minimal invasiveness and rapid functional recovery. Flexible intramedullary nailing (FIN), including titanium and stainless-steel variants, has emerged as a preferred modality, though its applicability in varying fracture types and patient subgroups remains under investigation.

Aim: The present study aimed to evaluate the clinical, radiological, and functional outcomes of paediatrics femoral shaft fractures treated with flexible intramedullary nails, and to identify complication patterns in relation to age, fracture stability, and body weight.

Methodology: This was a prospective observational study conducted over an 18-month period in a tertiary care hospital in India. A total of 30 children aged 6–12 years with isolated, closed femoral shaft fractures were included. All patients underwent surgical stabilization using flexible intramedullary nails (titanium or stainless steel), selected based on availability and fracture characteristics. Preoperative and postoperative clinical assessments, radiographs, and functional evaluations were performed using Flynn’s criteria. Follow-up was conducted at regular intervals up to 6 months post-surgery.

Results: In 80% cases, union was attained, delayed union was experienced in 15% and partial union at 5%.. Fifty percent of them were pain-free, and 90 percent recovered full or near-full range of motion clinically. Complications were rare and mainly minor including superficial infections, nail irritation and minor length discrepancies. Excellent or satisfactory results were demonstrated on the basis of functional assessment in more than 90% of children and poor results in just one case. There were found to be significant relationships between malalignment and functional grade, malalignment and limb length disparity, malalignment and complications, malalignment and lack of range of motion, and malalignment and delayed healing (p < 0.05).