Objective : The aim of this study is to evaluate both the anatomical and functional consequences of our treatment protocol of diaphyseal femoral fractures in children under 6 years old Methods : We conducted a retrospective analysis of a series containing 50 children in Strasbourg University Hospital whom had traumatic diaphyseal femoral fractures and underwent conservative treatment by traction followed by casting with a mean follow-up period of 25 months. Results : All fractures healed without complications i.e. gait disorders, back pain and limitation of activity. Results showed a significant correlation between the initial varus angulation and shortening which could influence the final remodeling result within the first 24 months. Using the Receiver Operating Characteristic curve, we developed the Initial Displacement Index on Traction (IDIT) which is the sum of both the initial varus in degrees and the initial shortening in millimeters. Conclusion : The treatment by initial traction followed by a cast for childrens ≤ 6 years old gives clinical and radiological results comparable with those reported for immediate casting method. The hospitalization period is longer in the traction method but with less exposure to general anesthesia (GA) and risks of secondary displacements.