The treatment of subtrochanteric femoral fracture in children between 4and 12 years of age is 
challenging. The optimal choice of internal fixation for these patients is controversial. The purpose of 
this study is to compare the outcomes and complications of titanium elastic nail and open reduction 
with plate fixation of subtrochanteric femur fractures in school-aged children. A total of 40 children 
aged 4 to 14 years with subtrochanteric femur fractures were treated at our hospital from January 
2018 to January 2020. We prospectively compared 20 children treated with titanium elastic nails with 
20 children treated with open reduction and plate fixation. The data included age, sex, body weight, 
fracture pattern, operation time, blood loss, and length of hospitalization. The outcomes were 
classified according to Flynn classification as excellent, satisfactory, or poor. All the demographic
characteristics were compared with statistical analyses. All 40 fractures united properly. No major 
postoperative complications were noted in both groups. No significant difference was found between 
the titanium elastic nail and open plating groups in terms of age, sex, fracture pattern, and length of 
hospitalization. We noted a significant difference between 2 groups in terms of operation time, 
hospital stay and blood loss. In total, we observed 11 excellent and 9 satisfactory results in the 
titanium elastic nail group, and 14 excellent results and 6 satisfactory results in the open plating 
group. Titanium elastic nail and pediatric hip plate fixation represent safe and effective methods in the 
treatment of subtrochanteric fractures in school-aged children.