Tibial fractures are the most common fractures of the long bones. Complications of tibial shaft fractures potentially include neurovascular compromise, compartment syndrome, delayed union, nonunion, or malunion, and osteomyelitis. Therefore, the management of tibial shaft fractures is very important for orthopedic surgeons. There are operative and non-operative options for the treatment of tibial shaft fractures. Non-surgical treatment is applied on closed (not open) tibial shaft fractures, naming as closed reduction and cast immobilization. Surgical treatments include external fixation, intramedullary nailing (IMN), and percutaneous locking plate (PLP). Surgery for tibial shaft fractures seems to have many benefits, such as better appearance, less pain, and discomfort after surgery, maintaining the length of the fractured bone, and faster recovery and return to work for the patient. Although non-surgical methods also have advantages, such as lower initial cost of treatment, no need for anesthesia and inexistence of possible complications of the surgery, the surgical procedure has better clinical results and better acceptance by the patients and it is more cost-effective and more affordable in terms of period of hospitalization and time to return to work. For these reasons, it is recommended to be considered as a more acceptable and more common treatment method. Concerning surgical options, IMN still seems to be the main acceptable method for the treatment of tibial shaft fractures, although PLP and external fixation have benefits too. Altogether, the final choice of management for each patient is specifically related to his/her condition, fracture type and the surgeon's decision.