Background: Diaphyseal femoral fractures in skeletally immature patients account for 1.4 - 1.7% of all fractures, and 7.6% of those involving the long bones. This study aimed to compare the outcome of operative fixation of femoral shaft fracture, between Titanium elastic intramedullary nails (TEINs) and Plating in skeletally immature patients. Patients and Methods: A prospective clinical study was conducted on 24 cases with diaphyseal femoral fracture at Zagazig University Hospitals (ZUH), Egypt and Tripoli Central Hospital in Libya from June 2021 until November 2021. Patients were divided into 2 groups, 12 cases in each group, first group underwent fixation with Titanium elastic intramedullary nails (TEINs), 2nd group underwent open reduction and internal fixation by plate and screws. All patients had Radiological evaluation to affected whole limb after exclude any serious injury with six months follow-up. Results: There was statistically significant difference (p value