Background: Femoral diaphyseal fracture especially at the shaft of femur was represented <2 % of all pediatric fractures. The aim of this Meta analysis study is to supply a good idea about the optimal fixation methods for femoraldiaphyseal fracture in school age children 5-14y based on the current evidence. Patients and Methods: A computerized research was performed in PubMed, Medline, Google scholar and Cochrane Library database to identify the relevant literatures that published until May 2020. By using RevMAN5.4 software the data pooled and analyzed for the meta-analysis. Results: the pooled data demonstrated a statistically significant difference P value < 0.05 in Operative Time (OT), Estimated Blood Loss (EBL) and Union Time (UT). Conclusion: According to the collected data from the included studies demonstrated that operative time, estimated blood loss and union time goes in favor to flexible nails. In the other side, using plate fixation is more stable and has lower rate of fracture malalignment more than retrograde flexible nail.So, based on the pooling data results we suggest the use of flexible nails with the stable femoral diaphyseal fractures, due to the minimally invasive technique, early union and weight bearing.