The tibia is particularly susceptible to open fractures because of its subcutaneous location. The status of the overlying soft tissue is regarded as the key determinant of fracture management strategy. Intramedullary nailing is widely recognized by the orthopedic community as the treatment of choice for most displaced, open, tibia shaft fractures due to the extent of soft tissue damage and the risk of infection. Both open and closed fractures are amenable to nailing. Occasionally, plates and external fixators are required to manage certain tibial fractures. This article describes the stabilization of an open tibia shaft fracture using an intramedullary nail. After copious irrigation and debridement of the fracture site, a transpatellar tendon split is used to expose the nail entry point. This is followed by fracture reduction, sequential reaming, and nail insertion and locking. Finally, the technique for proximal tibia traction pin insertion is demonstrated on the contralateral tibia.