[Objective] To compare the clinical efficacy of titanium elastic nail and proximal femoral locking compression plate in the treatment of femoral subtrochanteric fracture in older children. [Methods] Thirty-three children with subtrochanteric fractures in older children admitted to our hospital from January 2013 to January 2018 were selected and treated with titanium elastic nail and proximal femoral locking and compression plate fixation according to their respective indications, and were divided into 18 cases in the intramedullary nailing group and 15 cases in the plate group. The clinical results of the two groups were compared, and the general data were comparable. [Results] The surgery was completed successfully in both groups. The operative time, intraoperative bleeding, incision length, and hospital days were significantly less in the intramedullary nailing group than in the plate group (P<0.05). Both groups were followed up for a mean of 22 months, and bony healing was obtained in all cases. The differences in time to ambulation, time to full weight bearing, hip flexion and extension ROM and Harris score at follow-up were not statistically significant between the two groups (P>0.05). For imaging assessment, the excellent quality of fracture reduction was 55.56% in the intramedullary nailing group and 86.67% in the plate group, with a statistically significant difference (P < 0.05). Fracture healing time was significantly less in the intramedullary nailing group than in the plate group (P<0.05). The difference in bilateral femoral length was greater in the intramedullary nailing group than in the plate group, but the difference was not statistically significant (P>0.05). [Conclusions] Titanium elastic nail and proximal femoral locking compression plate can achieve good clinical results in the treatment of femoral subtrochanteric fractures in older children, and the methods of internal fixation can be selected according to their respective indications.