From 1995 to 1999, 19 patients (13 males and 6 females) were treated for Code 43 (distal segment) tibial fractures according to AO and Orthopaedic Trauma Association classification: there were 5 type A, 4 type B and 10 type C fractures. The mechanisms of injury included motor-vehicle accidents (n = 8), falls from heights (n = 8), a chainsaw injury (n = 1), and crushing injuries (n = 2). Five patients had associated injuries. All open fractures were managed acutely with wound debridement and application of an external fixator. Closed injuries were operated 1–16 days after injury (average, 6 days). The method of treatment depended on fracture comminution and soft tissue condition. Patients were available for follow-up for an average of 14 months. Results were evaluated by means of subjective and objective rating systems. All fractures in the series united with an average time to healing of 12 weeks. Anatomic or good alignment was obtained in all but 1 fracture. There were 7 excellent, 5 good, 5 fair and 2 poor results. Complications occurred in 2 patients (8%) and included 1 deep infection and 1 loss of reduction with malunion. The most important variables affecting the final clinical results were the type of fracture, the method of treatment, and the quality of reduction.