Background and objectives: Femoral overgrowth is not related to age, fracture level, or fracture anatomical location. This study measures the amount of bone overgrowth in operative and non operative ways to manage femoral shaft fractures in children. Methods: In this prospective cohort study, 50 participants with femoral shaft fractures were recruited at Shar/Shorsh teaching hospitals from June 2022 to June 2023. We collected patients' socio-demographics and clinical data (fracture side, site, and the mode of the treatment they received). The participants were treated with various methods. Later, we assessed the mean shortening at the time of bone union and overgrowth after one year of follow-up by x-ray and clinical exam. Results: Most shaft fractures were at the dominant side (74%), mid-femur (64%), and (52%) had undergone hip Spica. No-operatively managed cases comprised (52%). There was a significant difference in the femoral shortening before and after one year using the X-ray parameter (p=0.000). Moreover, a statistically significant difference (p=0.038) was seen in femoral overgrowth after one year of follow-up by x-ray assessment only. Additionally, non-significant differences were noted between all treatment types (hip Spica, plate and screw, elastic nail, and closed reduction + external fix) in femoral shortening at the time of union/femoral overgrowth using both x-ray and clinical assessment following a year. Conclusion: No significant difference was noticeable in the amount of bone overgrowth between operative and non-operative managements that caused no laming or restriction of daily activities. 

Dashty Sirwan Mohammad Rashid is an MBChB graduate and currently serves as a KHCMS Trainee in the department of orthopedics at Shar Teaching Hospital, under the Sulaimani Directorate of Health, Kurdistan Region of Iraq. His professional interests center on orthopedic surgery and clinical training, with a focus on improving musculoskeletal health outcomes. Rashid is actively involved in clinical research and orthopedic case studies and serves as the corresponding author for several academic works in his field.