Twenty-nine tibial shaft fractures were stabilized with the AO unreamed tibial nail. These included 13 type A fractures, 11 type B fractures and five type C injuries. Fourteen of the fractures were open. The AO unreamed tibial nail was the primary device used in all cases. Our series suggests that this is an easy device to insert and that its multiple locking options confer an advantage for the management of distal fractures. It also has a low soft-tissue complication rate. There was a delay in full patient mobilization and in the progression to fracture union. There was also a significant degree of implant failure with screw breakage in 21 per cent. This necessitated a high rate of secondary operative intervention. The high incidence (55 per cent) of anterior knee pain was also worrying and frequently necessitated nail removal. We feel that this implant may still have a role for distal fractures and in the multiply injured patient but do not feel that, in its current form, it is the ideal implant for the majority of tibial shaft fractures.