Aim: To evaluate the role of 90-90 hip spica in the treatment of femoral shaft fractures in children from 6 months to 6 six years of age. Place and duration of study: This descriptive cross sectional study was conducted at Unit A Department of Orthopaedics and Traumatology, MTI Khyber Teaching Hospital KPK Peshawar Pakistan from April 2015 to April 2017. Methods: Twenty three children of femur shaft fractures were included. Data including age, sex, fracture level, complications during treatment and final outcome with reference to radiology and functions were recorded. Results: There were 8 (34.7%) females and 15 (64.28%) males were included in the study. Seventeen patients (73.91%) showed excellent and good results and 6 patients (26.08%) showed fair and poor results. Mean time of fracture healing was 6.91±1.24 weeks. Two patients ended up with skin breakage and excoriation around the groin. Six patients came up with leg length discrepancy which was less than 2 cm on last follow up. Mean leg length discrepancy was 0.304±0.53 cm. Mean angular deformity was 9.22±5.62 degrees and mean rotational deformity was5.17±5.69 degrees. Conclusion: 90-90 hip spica is for femoral shaft fractures in children below 6 years is simple, effective and technically easier and with excellent results. With perspective of discomfort and difficult care of straight spica and complications attached to surgical treatment 90-90 spica can be adopted as a first choice and index procedure for femoral shaft fractures in children.