Carter CR, et al. - This study was intended to ascertain hospital and surgeon volume are correlated with outcomes after operative fixation of tibial shaft fractures. Researchers distinguished adults (≥18 year old) who had undergone operative fixation of diaphyseal tibial fractures in the New York Statewide Planning and Research Cooperative System data set from 2001 to 2015. They compared reoperation, nonunion, and other adverse event rates across surgeon and hospital volume applying multivariable Cox proportional hazards regression, adjusting for clinical and demographic factors. A total of 9,147 patients were included in the study. A clinically meaningful volume–outcome relationship was not found for either surgeons or hospitals despite the use of a robust database with rigorous statistical methodology. These data should not be used to rare complex injuries such as those with extensive bone loss or articular extension, which are not well represented by this study population. Thus, the data summarize that typical tibial shaft fracture, involving open or closed injuries, can be safely managed in the vast majority of orthopaedic settings and that this care does not necessarily need transfer to a specialty centers. Further study into orthopaedic volume–outcome associations could be strengthened by the use of functional outcomes (which would likely need well-organized multicenter prospective registries).