Tibia intramedullary (IM) nailing is a surgical procedure used to treat fractures of the tibia (shin bone), most commonly fractures of the tibial shaft. The tibia is the main weight-bearing bone of the lower leg and is particularly vulnerable to injury from motor vehicle accidents, falls, sports injuries, and direct trauma. IM nailing is considered the preferred treatment for most tibial shaft fractures because it provides strong internal stabilization while allowing early movement and weight-bearing. Before surgery, patients undergo imaging such as X-rays or CT scans to evaluate fracture pattern, alignment, and involvement of nearby joints. The procedure is performed under general or regional anesthesia. During surgery, the surgeon typically makes a small incision near the knee (most commonly just below or beside the kneecap) to access the medullary canal of the tibia. A guide wire is passed across the fracture site to align the bone fragments, and the canal may be gently widened (reamed) to accommodate the nail. A metal rod, usually titanium, is then inserted into the center of the tibia and advanced across the fracture. Once the nail is correctly positioned, locking screws are placed through the bone and into the nail above and below the fracture. These screws prevent shortening, rotation, and angulation of the bone, creating a stable, load-sharing construct that allows the tibia to heal while gradually resuming function. Modern nail designs allow treatment of not only mid-shaft fractures but also selected fractures closer to the knee (proximal) or ankle (distal) with careful technique. After surgery, patients are encouraged to begin early motion of the knee and ankle. Depending on fracture stability and surgeon guidance, partial or full weight-bearing may be allowed relatively soon after the procedure. Physical therapy plays an important role in restoring strength, range of motion, and gait. Healing typically occurs over several months. Common concerns include knee pain at the incision site, swelling, or delayed bone healing, while more serious complications such as infection, malalignment, or hardware failure are uncommon. Overall, tibial IM nailing has high success rates and is highly effective at restoring alignment, stability, and function after shin bone fractures.