External fixation of fractures of the tibial shaft is an old and well-established method oftreatment, but was not widely used because ofthe relatively unsophisticated nature ofthe devices, the problems of pin track infection and the perception that there was a high incidence of non-union.The development of modern fixation devices and improved techniques of pin site care have undoubtedly broadened the indications, the usage and the success rate of this method of treatment. Nearly all fractures of the tibial shaft, both open and closed can now be successfully treated with an external fixator.There is no particular age group in which it should not be used. It is important for a successful outcome that the fixators be applied properly and that close attention is paid to post-operative care. Dynamisation is an important factor in fracture union. A prospective study of a group of closed tibial shaft fractures has shown little difference in the union rate and the final outcome between intramedullary nailing and external fixation. No second operation to remove the metalwork is required in those treated by external fixation and theincidence of anterior knee painis very muchless.