Background: pathological fractures in children occur from many aetiology. The physician has to develop an individual strategy for management and rehabilitation, considering the biology of bone and the biomechanics at the fracture site to detect pathology of lesion and to reach perfect bone healing. Time-efficient protection and reconstruction of the child's musculoskeletal system is the aim of the orthopaedic surgeon's intervention. The whole strategy must be individualized to every situation. Objective: The goals of managing a child's pathological fracture are all based on establishing a diagnosis.  Fracture management is then based on five points:(a) relief the pain; (b) achieve local control of the pathological lesion; (c) skeletal stabilization, preservation of growth, and maintain anatomical alignment; (d) fracture healing; and (e) restoration of function. Patients and Methods: Our study was done over 20 cases of pathological fracture of lower limb in children in Al-Azhar University Hospitals (Al-Hossin and Saeid Galal hospitals) from January 2016 to December 2018. Imaging and radiology reports were used to determine fracture types. Complete fractures were classified to four major types: transverse, spiral, oblique and comminuted. In our study we use the Musculoskeletal Tumor Society (MSTS) scoring system to assess functional outcome for each patient. For lower extremity function, the MSTS used a 0-5 scale for the following variables: motion, pain, stability, deformity, strength, functional activity and emotional acceptance. Results: According to our study no patients with fractures underwent amputation, affection of neurovascular structures, or tumour progression on therapy. Pathologic fracture was not an indication for any of the amputation procedures, only the tumour pathology in an indication. Two patients refused surgery. Only one patient had a local recurrence after limb salvage surgery, and underwent no further surgical intervention.