In the adult population, tibial shaft fractures make up a significant portion of both closed and open long bone fractures. These injuries are often associated with high-energy trauma and have considerable financial impact on healthcare resources. Hence, it is crucial that these injuries are appropriately managed to provide optimal patient outcomes. The OTA/AO classification is frequently used to describe these fractures and are used in conjunction with the Gustilo–Anderson classification when open fractures are present. Along with conventional radiographs, modern imaging techniques such as computed tomography should be considered given their associations with intra-articular fractures. Primary treatment strategies aim to minimize further insult to soft tissues surrounding the fracture, prevent and/or recognize compartment syndrome, re-establish limb alignment and allow for early mobilization. Closed fractures may be treated conservatively or surgically, while open fractures require surgical intervention, sometimes in multiple stages. Postoperative care, including rehabilitation and weight-bearing guidelines, depends on injury severity and fracture type. Although scoring systems for fracture healing exist, specific validated functional outcome measures for tibial fractures are lacking. This review is aims to re-visit basic concepts and provide updates in the management of tibial shaft fractures.