Objective To investigate and evaluate the efficacy of elastic stable intramedullary nailing (ESIN) and bone plate set (BPS) in the treatment of femoral shaft fractures in children. Methods The study involved 39 children with femoral shaft fractures, of whom 18 children were treated with ESIN (ESIN group) and the other 21 with BPS (BPS group). In ESIN group, the nails were insert-ed through a micro incision in the medial and lateral epicondyle after closed reduction under C - arm ob-servation. In BPS group, the plates were placed on the lateral side of femur by means of open reduction and internal fixation. Results All the patients were followed up for 4-20 months (mean 10 months), which showed fracture healing in all the patients. The mean operation time, incision length, perioperative blood loss, length of hospital stay, time of fracture healing and time of weight bearing were (40.0±17.0) minutes, (2.0±0.6) cm, (30.0±8.0) ml, (7.0±1.5) days, (8.0±1.2) weeks and (6.0 ±1.0) weeks respectively in ESIN group, and (70.0±25.0) minutes, (12.0±1.1) cm, (150.0±30.0) ml, (14.0±5.2) days, (13.0±1.9) weeks and (4.0±1.3) weeks respectively in BPS group, with statistical difference between two groups (P < 0.05). Conclusions Compared with BPS, ESIN has the advantages of less operation wound, less perioperative blood loss and shorter time for fracture healing. ESIN can protect the microenvironment important for the fracture healing, and is one of ideal op-tions for treatment of femoral shaft fracture in children.