OBJECTIVE To compare titanium elastic nails with Thomas splint traction treatment for femur shaft fracture in children. METHODS The descriptive randomised study was conducted at Abbasi Shaheed Hospital, Karachi, from January 2013 to December 2014, and comprised children aged 6-12 years with simple femur shaft fractures. The patients were randomised into two equal groups. Group A patients were treated with titanium elastic nail and group B patients with Thomas splint traction. Patients were mobilised without weight-bearing on the 5th to 7th postoperative day. In group B, traction was maintained for about 8 to 10 weeks. After splint removal, patients were referred to physical therapy. Patients were available for one-year follow-up. RESULTS There were 30 patients; 15(50%) in each of the two groups. Those group A had full weight-bearing at 4-6 weeks and early return to routine activities compared to group B patients who took 8-12 weeks. The results were Excellent in 12(80%) patients in group A and 6(40%) patients in group B Postoperative superficial infection occurred in 3(10%) patients. CONCLUSIONS Titanium elastic nailing is an effective treatment of femur shaft fractures in children.