Objective：To compare the clinical effects of elastic intramedullary nail and steel plate in the treatment of tibial shaft fracture in children. Methods：A total of 110 children with tibial shaft fractures treated in the Department of Orthopaedics of Dazhou Central Hospital from January 2017 to January 2021 were selected，including elastic intramedullary nail group（n=58） and steel plate group（n=52）. The intraoperative blood loss，total incision length，operation time，hospital stay，hospitalization expenses，fracture healing time，functional recovery scores and complications were compared between the two groups. Results：The total incision length[（4.1±0.8） cm]，operation time[（42.0±6.2） min]，hospitalization cost[（15 000±7 000） yuan] and fracture healing time[（10.6±1.1）weeks] in the elastic intramedullary nail group were lower than those in the steel plate group[（10.2±1.4） cm，（65.0±7.6） min，（21 000±5 000） yuan and （12.4±1.3） weeks]. The excellent and good rate of functional recovery in the elastic intramedullary nail group（98.3%） was significantly higher than that in the steel plate group（86.5%）（P<0.05）. There was no significant difference in intraop－erative blood loss（using tourniquet） and hospital stay between the elastic intramedullary nail group and the steel plate group（P >0.05）. In terms of complications，the infection rate in the elastic intramedullary nail group（1.7%） was lower than that in the steel plate group（13.5%），and the joint stiffness rate in the elastic intramedullary nail group（15.5%） was higher than that in the steel plate group（3.8%）. There was no significant difference in fracture alignment，delayed fracture healing or nonunion and unequal length of both lower limbs between the two groups（P >0.05）. Conclusion：The indications of elastic intramedullary nail and steel plate are different. Elastic intramedullary nail has more advantages in the selection of internal fixation of tibial shaft fractures in children，and is suitable for clinical application.