Background: Close reduction and casting which continues to be the gold standard of care, and is a successful treatment for the great majority of the paediatric tibial shaft fractures. On occasion severe shortening, angulation or mal-rotation at the fracture site prevents reduction from being maintained necessitating surgical intervention options are external fixation, plating, flexible intramedullary nailing etc. We decided to carry prospective comparative study to compare clinico-radiological outcomes with antegrade versus retrograde TENS nailing.Objectives: To compare clinico-radiological outcomes with antegrade versus retrograde TENS nailing. Methods: Patients were operated with 26 patients in antegrade TENS nailing group and 24 patients in retrograde TENS nailing group. Results:There was no significant difference in both groups as regards age, sex, time required for the surgery, image intensifier time, length of incision, time required for soft tissue healing, pain etc. Retrograde TENS nailing has better results in the management as regards incidence of delayed union. Retrograde TENS nailing has more incidence of soft tissue irritation and infections compared to the antegrade TENS nailing. Conclusion: Retrograde TENS nailing has less incidence of delayed union and malunion and has more incidence of soft tissue irritation and infection as compared to antegrade TENS nailing