Objective To compare the clinical and radiological results in unstable pediatric femoral shaft fractures treated with either limited open reduction or closed reduction and titanium elastic nailing combined with end caps. Methods Retrospectively analyze the data of total 54 cases of 5-13 years children with unstable femoral shaft fractures, from January 2012 to June 2016, were treated with titanium elastic nail and end caps.24 cases were treated with limited open reduction and 30 cases were treated with closed reduction. The intraoperative indexes and postoperative radiological results, clinical outcomes and complications of the two groups were assessed.Results Both surgical and fluoroscopy time were significantly longer in group B.The cases of intraoperative fracture were fewer in group A.There were no significant differences between intraoperative estimated blood loss, length of stay,fracture healing time, partial weight bearing time and complications.Applying Beaty imaging result to group A, satisfactory results were documented in 22 cases, unsatisfactory results in 2 cases.In group B, satisfactory were seen in 16 cases, unsatisfactory in 14 cases.According to the TEN outcome scoring system, group A was excellent in 15 cases, good in 9 cases.In group B, excellent were seen in 5 cases, good in 22 cases, poor in 3 cases.The results of early Beaty imaging were statistically different between the two groups.At the last follow-up, there was no significant difference between the two groups in terms of clinical and radiological results．Conclusions Limited open reduction is an superior method of limited open reduction to gain better reduction fixation and to decrease complications, the time of surgical and fluoroscopy．