The tibia is an exposed bone with vulnerable soft tissue coverage and is therefore predisposed to local soft tissue problems and delayed bone healing. The objective in distal tibial fracture treatment is to achieve stable fixation patterns with a minimum of soft-tissue affection. The risk of soft tissue breakdown and bone healing complications is more likely related to open reduction and plating. Intramedullary nailing is an effective and well-established method for the treatment of a wide spectrum of tibial fractures. Nevertheless, the handling of metaphyseal and open fracture remains challenging. Surgical and technical advancements have opened up new possibilities to broaden the indication of intramedullary nailing in these areas. The intramedullary nailing of metaphyseal fractures is associated with an increased incidence of deformities, which can result from instablity after fracture fixation. Proximal tibial fractures treated with intramedullary nail may result in malunion with apex anterior and valgus deformitis due to the pull of pateller tendon, poor nail cortex fit. Similary, displaced extra-articular fractures of the distal tibia can be difficult to treat, with residul varus, valgus, recurvatum, or possible procurvatum. Blocking or poller screws can be inserted in the coronal and sagittal planes placed adjacent to an intramedullary nail to functionally decrease the width of the wide metaphyseal medullary canal in the proximal and distal tibial fractures, this ensures that the intramedullary nail follows the native anatomy of the canal, thus maintaining crucial stabilizing contact with the tibial cortex.