Tibial fractures are common fractures in adults. Most are due to high energy trauma, although some occur during sporting events. Most patients are admitted to the hospital. Injuries occur in a spectrum ranging from low energy closed fractures to high energy open fractures. For fractures with minimal soft tissue injury and fracture displacement, cast treatment can be attempted. In adults, however, most tibial shaft fractures are treated with surgical repair. In severe cases with damage to the soft tissue envelope that precludes acute definitive fixation, an external fixation device placed across the fracture will allow the soft tissue envelope to “cool off”. Surgical repair typically involves placement of an intramedullarynail into the hollow portion of the bone. Screws are placed at the top and bottom of the nail to stabilize the fracture and prevent rotation or shortening. Most patients stay 1-2 days in the hospital. Post-operative weight bearing status depends on the severity of the injury and the stability of the fixation. Pool therapy is very useful during this time as it allows for some motion without putting stress on the surgical repair. The biggest risk after surgery is blood clots in the veins of the legs and pelvis. All patients receive a medication called low molecular weight heparin for the first two weeks after surgery. Full recovery for most tibia fractures takes 6-8 months; however, some fractures develop a condition called nonunion and require further surgery.