Simple spiral tibial shaft fractures are well suited to nonoperative treatment, and usually shorten no more than the amount seen on initial x-rays. Displacement greater than 30%, especially for distal fractures, suggests an increased risk of secondary displacement. Rotational alignment is important to correct. An associated fibular fracture is common, and increases instability. If the fibula is intact, it prevents symmetric shortening and may produce varus angulation.
Operative treatment is an option if there is significant deformity, or strong patient preference.