High-energy tibial shaft fractures are among the commonest injuries resulting from high-energy trauma. Skeletal fixation of tibia fractures resulting from high-energy trauma has undergone a number of fundamental changes over the past few decades. These changes are because, in part, of a better understanding of the intimate association between the disruption of the soft tissue envelope of the tibia and the osseous injury, increased implant choices, and the development of protocol-driven studies to evaluate treatment options.