Background: There is considerable debate regarding the best method of treatment of tibial fractures. A number of treatment methods have been well documented. External fixation is used mainly for the treatment of open tibial shaft fractures. When the external fixator was not available, skeletal traction is used for temporary stabilization, especially if closed intramedullary nailing is to be performed in 48-72 hours.

Methodology: The study conducted was a comparative analysis. The study population comprised of a total number of 34 patients who had closed fractures of the tibial shaft, who attended the accident and emergency or out patients department of Liaquat University Hospital, Jamshoro and Hyderabad. This study was carried out from June, 2010 to July 2012. Only patients who fulfilled the underlying criteria were included in the study after obtaining informed consent.

Results: A total of 34 patients with closed recent fracture of shaft of tibia were treated by intramedullary nailing and conservatively with application of above knee plaster cast. Out of 34 patients, 17 patients were managed with intramedullary nailing with reaming and 17 were managed closed reduction and a cast. The two groups were comparable with regards o radiographic union, clinical union and time off work. These were also comparable with regard to complicationsi.evarus or vulgus angulation, rotation and shortening.

Conclusion: We conclude that treatment of displaced closed fractures of tibial shaft with intramedullary nailing with reaming produced functional results that are superior to those obtained with use of a plaster cast.