Closed tibial shaft fractures with severe soft tissue trauma require urgent surgical treatment to minimize complications such as soft tissue necrosis, infection, compartment syndrome, and nonunion. Although time to union and complications are similar to open tibial fractures, these injuries often are treated as low energy closed fractures. The method of internal fixation depends not only on the fracture pattern, but also on the condition of the soft tissues. Unlike plate osteosynthesis, the authors believe that virtually all complex closed tibial fractures may be treated with an unreamed tibial nail if proximal and distal interlocking is possible. With severe closed soft tissue trauma (Grades 2 and 3), an unreamed nail may have biologic and mechanical advantages. In a prospective study, 21 closed tibial shaft fractures with severe soft tissue trauma (Grades 2 and 3) were treated with an unreamed nail. The mean followup was 29 months. All fractures healed in an average time of 23 weeks. However, 3 patients required a bone graft, and in 3 patients the fixation was revised. One infection occurred after an exchange reamed nailing. Because of the low infection and low nonunion rate, the authors recommend unreamed interlocking tibial nails for closed tibial shaft fractures with severe soft tissue trauma.