Background: Elastic intramedullary nailing is a method of diaphyseal fracture osteosynthesis in children. This technique has many advantages. Namely, there is primary bone union with avoidance of growth plate injury, early weight bearing, and minimally invasive surgery with a short duration of hospitalization. Objective: In this study, we evaluated radiological and functional results of treatment of open tibial shaft fractures in children using intramedullary elastic nail. Patients and Methods: This study was a prospective clinical study that included 24 cases with open tibial fractures treated with intramedullary elastic nail at Zagazig University Hospital (ZUH), Egypt and in Tripoli Central Hospital in Libya from June 2020 until September 2020 with six months follow-up. All patients were assessed radiologically by anteroposterior and lateral plain radiographs of the tibia that included the knee and ankle to limit unnecessary radiation. Results: The majority of studied group were excellent in 19 cases clinically according to Ketenjian and Shelton Criteria and 23 cases were united using radiological assessment. Only two cases had superficial skin infection and just one case had delayed union. Conclusion: Flexible intramedullary nailing is an effective treatment option in patients with open fracture (gustilo type I, II), four to fifteen years age group.