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Abstract Background: Femoral shaft fracture is a common pediatric injury for which variable methods of treatment are used. We randomize a study to assess 2 operative methods Material and methods: from July 2019 to February 2020, we treat 26 patients with fracture shaft femur. Patient age was 6 - 12 years. In the first group, 26 patients were treated with titanium elastic nails (TENS). The other 26 patients were treated with open reduction and internal fixation using narrow AO plates. Clinical and radiographic follow up was done in regular intervals (2 weeks, 4 weeks, 2 months, 3 months, 6 months) and the Final clinical and radiographic results were evaluated using Flynn et.al (2001) scoring system. Results: In the TENS group,11 patients had excellent results and 2 patients had good results with minor complications. Union achieved with an average of 7.6 weeks. In the plating group, 10 patients had excellent results, 3 patients had good results with minor complications. Union achieved with an average of 8.6 weeks. Conclusion: TENS is a simple, reliable, effective, and minimally invasive method of treatment of pediatric femoral fractures |