Femoral stem fractures are one of the more common types of fractures in children. They are more common in males and occur nearly three times as often as in females. The two peak periods for fractures are childhood and adolescence. Most fractures in childhood occur because of low-energy injuries from ground sports such as skateboarding or falls, so most are simple fractures of the femoral stem. In contrast, adolescent fractures are often high-energy injuries, such as car and motorcycle accidents, or falls from heights. Therefore, they are mostly accompanied by compound injuries, such as multiple fractures, knee and ligament injuries, epiphyseal injuries and thoracic and abdominal organ injuries. The principle of treatment for femoral stem fractures in children is to observe the principle that simple and effective treatment is the best treatment, to restore the axis and rotational deformity of the fracture, and not to emphasize anatomical repositioning. The younger the child, the greater the potential for bone remodeling and the greater the chances of normalization. According to this guideline, the treatment of femoral stem fractures in children is mostly conservative. However, due to the introduction of flexible intramedullary pins in the 1980s, the treatment of femoral stem fractures in children, both internationally and nationally, has changed significantly, i.e., there is an increasing trend toward surgical intervention. In actual clinical work, there are many treatment methods for femoral stem fractures, including conservative treatment such as suspension and horizontal skin traction brace fixation, single hip cast fixation or single hip cast fixation after traction, and surgical treatment such as elastic and locked intramedullary pin fixation, compression plate and bridging plate fixation, and external fixation brace fixation. Although most children with femoral stem fractures can be treated with good outcomes, complications are not uncommon, including delayed bone healing and osteonecrosis or infected osteonecrosis, limb inequality, angular deformity, and vascular and neurological injury. The choice of treatment is based on the patient’s age, the patient’s weight, the concomitant injuries, and the site and type of fracture.