There are more potential treatments for tibial fractures and more potential complications of those treatments than there are for any other type of fracture. The American Academy of Orthopaedic Surgeons recently reviewed malpractice claims to identify the procedures and diagnoses that have most commonly resulted in legal action. Among all orthopaedic conditions, fractures of the tibia and fibula ranked second with regard to the total number of patient malpractice claims, accounting for over thirty million dollars in indemnity. The National Center for Health Statistics reported that more than 490,000 fractures of the tibia and fibula occur each year in the United States. Although many tibial fractures may be managed nonoperatively, fractures for which nonoperative treatment has failed, open fractures, fractures with an associated compartment syndrome, and high-energy fractures require operative stabilization. Surgical options include external fixation, plate fixation, and intramedullary nailing with or without reaming. Although there is a consensus among orthopaedic surgeons with regard to the optimal treatment of fractures of the femoral shaft, the appropriate treatment of closed and open tibial fractures remains controversial.