Two hundred ninety-three consecutive fresh tibial shaft fractures in 276 patients were treated operatively in a 10-year period. Eight patients required amputations. The early and late complications in both closed and open tibial shaft fractures are separately described and discussed. More than 90% of the closed fractures needed a normal healing time; osteitis developed in 2.5%. Eighty-eight per cent of the closed fractures had an excellent or acceptable end result. In the open fractures delayed union occurred in 9.0% and nonunion in 6.8%. Osteitis developed in 8.35%. Seventy-five per cent of open fractures and an excellent or good end result; one fourth had an acceptable or poor end result. In the series discussed there was a high incidence of direct trauma with soft-tissue injury in both closed and open tibial shaft fractures. There was a positive relationship between the degree of soft-tissue damage of the fractured lower leg at admission and the frequency of early postoperative problems. The frequency of late complications was more dependent on the fracture form and the method of the first operative stabilization.