Hendrickx LAM, Virgin J, van den Bekerom MPJ, et al. - This study was conducted to systematically review all currently available evidence to evaluate the incidence of complications and rate of re-operations following intramedullary nailing of traumatic tibial fractures to improve the understanding on how we may enhance trauma care for patients with tibial shaft fractures. Researchers carried out to search trip Database, Medline, Scopus and Cochrane Library on September 7th, 2018. They reported incidence of complications and rate of re-operations with descriptive statistics. Analysis included a total of 51 studies enrolling a total of 8,110 patients treated with intramedullary nailing for traumatic tibial fractures. Results illustrate that for tibial fractures, patients treated with intramedullary nailing need to be consented for high probability of adverse events as anterior knee pain, subsequent surgical procedures and bone healing problems are relatively common. Nevertheless, according to the recent data it remains difficult to distinguish specifiers and determinants of an individual patient with specific fracture characteristics at risk for complications. Future studies are needed to develop patient specific risks models for complications and re-operations, such that clinicians can anticipate them and adjust and individualize treatment strategies.