Objective To compare the complications and clinical outcome of reverse less invasive stabilization system (LISS) and elastic nailing for the treatment of subtrochanteric femur fractures in older children.Methods Fifteen children aged from 9 to 15 years old were admitted in this hospital for the treatment of subtrochanteric fractures.The 15 patients subtrochanteric fractures were fixed with reverse LISS.The other 26 patients,who underwent elastic nail fixation for the treatment of subtrochanteric fractures in the same period,were taken as controls.Operative indications,hip joint function and complications of these 2 groups were retrospectively analyzed.Results The average follow-up period of the patients was 30.5 months in LISS group,and 36.2 months in the elastic nail group.No significant difference between these 2 groups was found in fracture healing time,full weight-bearing time and average hospital stay.However,the patients of the LISS group had longer operation time (60.0 ± 10.6 min vs.40.5 ± 7.4 min,P＜0.05),less intraoperative blood loss (130.0 ± 55.0 ml vs.30.5 ± 15.0 ml,P＜0.05) and more hospital costs (25 000-± 800 RMB vs.12 000 ± 500 RMB,P＜0.05).The postoperative complication of these 2 groups was no statistically different,but the patients of the LISS group had a higher incidence of incisional pain,and the elastic nail group had a higher incidence of misalignment.Average Sanders hip function score of LISS group was not significantly different from that of elastic nail group (58.20 vs.58.77,P＞0.05).Conclusions The clinical outcome of LISS is comparable with elastic nailing for the treatment of subtrochanteric femur fractures in older children.The fixation device should be selected according to the associated injury,severity of soft tissue injuries and family economic status.