The tibia is the most commonly fractured long bone. Shaft fractures often result from high-energy trauma; however, they may also manifest insidiously following application of low-energy torsional forces or as stress fractures. The subcutaneous position of the tibia makes open fractures relatively more likely, although most fractures still maintain an intact soft tissue envelope. Closed injuries tend to be associated with simple fracture patterns, whereas more complex fracture configurations are more common in older osteoporotic patients. Higher-energy injuries occur more frequently in men between the ages of 20 and 45 years. Commonly associated injuries include fibular fracture, disruption to proximal or distal tibiofibular joints, soft tissue knee injuries or coexistent tibial plafond fracture.