Objective: We evaluated the clinical and radiographical outcomes in pa- ediatric patients with diaphyseal femur fractures who were treated with intramedullary titanium elastic nails. Methods: Twenty-two patients (15 boys, 7 girls; mean age 7.6 years; range 6 to 12 years) with diaphyseal femur fractures who were treated with ret- rograde titanium elastic nailing (TEN) were evaluated in the study. 15 of the fractures were located mid-diaphyseally, 4 proximal diaphyseally and 3 distal diaphyseally. Open reduction via lateral incision was applied in cases in which closed reduction could not be achieved. Anterior-posterior and lateral radiographical views of the femur were used in the follow-up period. Gait patterns, range of motion of the knees and the hips, hospita- lization time, time to union, limb length discrepancy between the lower extremities, and any complications were evaluated in the patients. Flynn's TEN scoring system was used to evaluate the outcomes. Results: Union was obtained in a mean of 6.8 weeks (range 5 to 11 weeks) in all of the patients. The anterior-posterior radiographs indicated that normal alignment was achieved in 19 patients. Two patients had a 5 degree varus malalignment and one had a 6 degree valgus malalignment. Two patients had a 6 degree anterior malalignment in the lateral radiographical view. Average limb length discrepancies of 7 mm were seen in 2 patients and of 6 mm were seen in 3 patients. Hip and knee motion were mildly restricted in one patient. Gait pattern was symmetric in all but one patient. Superfici- al wound infection was detected in one patient. None of the patients had nonunion, early closure of the epiphyseal plate or fracture following TEN extraction. Fifteen patients had excellent and 7 had good results according to Flynn's criteria. Mean hospitalization time was 4.2 days (range 3 to 9 days) and mean follow up period was 20.2 months (range 14 to 24 months). Conclusion: Intramedullary TEN is a successful method that yields good results for paediatric diaphyseal femoral fractures