Background: Pediatric femoral shaft fractures are one of the most common pediatric orthopedic fractures and are the most common reason for pediatric hospitalization due to orthopedic injury. In Ethiopia, femur fractures are a common and significant injury in children. But the information about the prevalence and mechanisms of femur fractures among children is scarce. Objective: To assess the prevalence of pediatric femoral shaft fractures and its associated factors at Tibebe Ghion Specialized Hospital, Bahirdar, Ethiopia. Methods: Institutional based cross-sectional study was conducted on Records of 298 pediatric patients with extremity fractures who visited the Orthopedic Emergency Department of Tibebe Ghion Specialized Hospital from January 2019 to August 2020. Data collection was done by using a pre-tested checklist comprising sociodemographic and characteristics of femur shaft fractures data. Data analysis was done by using SPSS Windows Version 23. Chi-square test (χ2) was used to identify factors associated with femur shaft fracture. A P-value < 0.05 was considered statistically significant. The results of the analysis were presented in texts, tables, and figures. Result: Amongst the 298 patients, 74(24.8%) sustained femur shaft fractures which is the largest type of fracture. 43.2% of these injuries occurred in the adolescent age group and 50% of them happened due to falls while 33.8% were from road traffic accidents. 64.9% of femur shaft fractures involved the mid-shaft region of the femur and 41.9% of these injuries were simple transverse in the pattern while 27% were comminuted. The age of the patient showed a significant association (p-value 0.029) with the rate of occurrence of femur shaft fractures in children. Conclusion: The magnitude of femur shaft fracture amongst children with extremity fractures in the study area was significantly high. The majority of these injuries occurred in the adolescent age group. Falls and road-traffic accidents were the main causes of these fractures. Patient age was found to be associated with the rate of occurrence of femur shaft fracture in children. Attention should be given to children with pediatric femur fractures and all the necessary implants and materials should be available for treating these injurie