Tibial fractures are the most common long-bone fractures. Orthopaedic surgeons, regardless of their subspecialty, often must treat these injuries, which range from low-energy, minimally displaced fractures to limb-threatening injuries with neurologic and vascular damage and significant damage to the soft-tissue envelope. Tibial shaft fractures are often prone to complications, such as apex-anterior and valgus malalignments after nailing of the fractures in the proximal one third of the tibia, infection after open fractures, and aseptic nonunions. Understanding the common complications will aid in preventing them and will allow recognition and provide treatment strategies when such problems occur.