The difficulty of reducing and holding fractures of the tibial shaft, especially those of oblique configuration, is well known. A high incidence of malalignment after closed treatment of fractures of the distal third of the tibial shaft, as compared with fractures in more proximal sites, has also been reported. In 29 of 37 fractures in the present study treatment by closed methods had failed. In highly selected cases of closed tibial shaft fractures, notably those in the distal third and at the middle third-distal third junction with an oblique or a spiral configuration and an unacceptable position after closed reduction, simple screw fixation followed by plaster immobilization provides an effective treatment alternative.