Background: Tibial shaft fracture is the third most common skeletally immature long bone fracture after the femur and forearm, representing 15% of all skeletally immature bone fractures. The purpose of this study was to improve outcomes of management of tibial shaft fractures in skeletally immature patients 15 years of age or less by elastic intramedullary nailing. Patients and Methods: This study was a prospective study conducted at Orthopedic Surgery Department, Faculty of Medicine, Zagazig University in the period from October 2021 to April 2022. Twenty four patients were included in this study all of them suffering from displaced diaphyseal fractures either closed or open fracture Gustilo & Anderson type I & II of the both bone leg in skeletally immature patients aged less than 15 years. Results: All patients in this study achieve full union by the end of follow-up, with mean union time 10 weeks, 50% of the fractures united completely within 7 to 9 weeks, while 41.7% united from 10 to 12 weeks. Only 2 patients 8.3% had delayed union. No unsatisfactory outcome reported in this study, all patients were either excellent 79.2% or satisfactory in 20.8%. According to Flynn criteria. Regarding the complications, the incidence of complications in our study was 25%, distributed as follow 8.3% of patients suffering from entery site irritation, other 8.3% patients presented with delayed union. Conclusion: Elastic intramedullary nailing is an effective and safe treatment method for tibial shaft fractures in skeletally immature patient, even those with open fractures.