The purpose of this study was to analyze retrospectively pediatric femur fracture patients with concomitant head injury to determine whether time to fracture fixation affects central nervous system, orthopaedic, or additional complications. Twenty-five patients with a Head Abbreviated Injury Scale score of > or =3 and a femoral shaft fracture were reviewed. Patients were divided by time to treatment for their femur fracture. Average stay was 10.5 days for the early group and 18.5 days for the late group, the only statistically significant finding. Orthopaedic and central nervous system complications were similar between the two groups. Sixteen additional complications were found in the late group versus three for the early group. Femur fractures in the head-injured pediatric patient can be adequately addressed with early or late fixation with similar long-term outcomes. Early femur fracture fixation may decrease the length of hospital stay and the number of nonorthopaedic, nonneurologic complications.