Tibial shaft fractures are among the most prevalent orthopedic injuries, representing about 2% of all fractures in adults and 37% of long bone fractures. These injuries occur frequently in both high-energy trauma scenarios and low-energy falls, with significant variations in treatment based on fracture severity and patient age. The Gustilo-Anderson classification guides treatment based on fracture severity. Conservative treatment with casting is effective for stable fractures but carries risks like delayed union and malunion. Surgical management, including external fixation, intramedullary nailing (IMN), and plating, is essential for displaced or complex fractures. External fixation offers rapid stabilization but has higher infection risks. IMN, preferred for its stability and minimal soft tissue damage, is effective for diaphyseal and open fractures. Plating is less common but useful for specific fracture patterns. Management of tibial shaft fractures requires a tailored approach considering fracture type, patient health, and potential complications. Both conservative and surgical methods have specific advantages and limitations. Further studies are needed to optimize treatment strategies and improve patient recovery.