Tibia shaft fractures are common in all age groups. For these fractures; Conservative and surgical treatment methods are available. In surgical treatment, numerous surgical methods such as plate screw fixation, external fixator, and titanium elastic nail and K-wire fixation have been defined. The aim of the present study was to present the results of patients for whom external fixator combined with titanium elastic nails or titanium elastic nails alone were applied due to tibia shaft fractures. The study included 40 patients treated for tibia shaft fracture in our clinic between January 2016 and January 2019. Combined external fixator (EF) fixation was applied to patients who were found to be instable after Titanium elastic nail (TEN) application during the surgery. In clinical evaluation, Flynn classification, time to fracture union, fluoroscopy count, reoperation and time to full weight bearing were used. The results of patients for whom EF combined with TEN were applied were compared with the patients who had only TEN. Thirty patients were treated using TEN and 10 patients using EF combined with TEN. After 12 months of follow-ups, fracture union was achieved in all patients. There were 5% sagittal and 2.5% coronal plane angulation. Patients developed angular deformity of an average of 2.43 ± 1.9 degrees in the coronal plane and 2.65 ± 1.9 degrees in sagittal plane. Lower percentages of angular and rotational deformity were observed compared to the literature. Despite the disadvantages of using a greater number of fluoroscopy and longer operation periods in patients who underwent TEN+EF, these patients were mobilized earlier. It was concluded that combined EF application is a more feasible method in patients with pediatric tibia shaft fracture for whom stable fixation cannot be achieved with TEN.