Tibial fractures in the skeletally immature patient are usuallytreated non-operatively. However, in the last decade there hasbeen an increasing interest in surgical stabilization, particularly forunstable closed tibial shaft fractures as well as open fractures orthose with associated soft tissue injuries. Elastic stableintramedullary nailing (ESIN) is commonly used for otherdiaphyseal fracture locations. Its advantages are minimallyinvasive surgery with a short hospitalisation duration, secondarybone union and early weight bearing. The purpose of our studywas to investigate the safety and efficacy of elastic stableintramedullary nailing for paediatric tibial shaft fractures usingtitanium elastic nails (TENs). To our knowledge, this is one of thelargest series reported in the literature of this specific fixationtechnique. Between April 2013 and July 2013, a prospectivestudy was conducted on twenty patients (2 females and 18males) with a mean age 8.95 years old (range; 6-16 years).Patients were followed up for a mean of 5 months(range; 4 – 6 months) after surgery. All patients undergoneESIN using two nails without postoperative casting. At the time of the last follow-up, Flynn scoring systemshowed 16 excellent cases, 3 satisfactory cases and only 1poor case.There was no statistical difference in the outcome of openfractures (9 cases) and closed fractures (11 cases) (p- value0.089), and no statistical difference in the outcome of differentfracture patterns, 42D/4.1 (10 cases) and 42D/5.1 (10 cases) (pvalue0.513). We recommend the use of this technique in most oftibial shaft fractures whether open or closed and in differentfracture patterns. This is due to being simple, non-invasive,and rapid, with low rates of infection, refracture and leavingan aesthetically pleasing scar, which compensate for thistechnique’s greater cost.