Specific problems in the treatment of the segmental fracture of the tibial shaft. The management, the postoperative problems and the functional results of 40 patients with 41 segmental fractures of the tibial shaft were reviewed. 63.4% of the fractures were open and 75% of the patients had one or more associated lesions. All fractures were treated operatively: 23 (56.1%) with a single or double plate osteosynthesis and 18 (43.9%) with an external fixator. 37 fractures could be followed-up until bony consolidation. The postoperative problems of each stabilization method are discussed. A pseudarthrosis is seen in 18.9% and a deep infection in 10.8% of the patients. A good functional result could be obtained in 78.4%. The segmental fracture of the tibial shaft is connected with specific biomechanical and fracture healing problems. The vascularization of the intermediate fragment is severely disturbed by the trauma itself and may surely not be endangered secondarily by the operative procedure.