A followup study of 103 patients with long spiral or oblique fractures of the shaft of the tibia distal to the isthmus of the intramedullary canal was done. The injuries were caused by indirect violence, and consequently the soft-tissue damage was minimal while the degree of initial displacement and instability varied considerably. The initial management was conservative by closed reduction and long plaster cast. Failure to retain the fragments in an acceptable position occurred in 32 cases, and in these closed intramedullary compression nailing with the Kaessmann rod was undertaken 9 days postinjury on an average. The ultimately nailed 32 fractures had a significantly shorter clinical union time than the 71 conservatively treated fractures in spite of the initially more severe average lateral displacement. Deep infections were not seen. The malunion rate was 9% after compression nailing and 27% after conservative treatment. The functional recovery showed a marked correlation with the anatomic restoration.