One hundred and four nonpathological fresh femur fractures not involving the neck or condyles in two groups of preschool children were retrospectively compared and followed up for a minimum of 3 years. Group I was treated by a spica cast and group II was treated by a titanium elastic nail (TEN). The mean age of the children was 4.5 years. TEN was statistically better in terms of union (P=0.000), shortening (P=0.016), sagittal angulation (P=0.018), coronal angulation (P=0.022), rotation (P=0.014), earlier weight bearing (P=0.000), and earlier return to nursery (P=0.000). However, both groups had a similar overgrowth rate and hospital stay time. TEN in preschool children is a safe choice but involves a scar, risk of infection, and the need for a second operation.