Tibial fractures are the most common long bone fractures. The benefits of intramedullary nailing of these fractures include load sharing, sparing of the extraosseous blood supply and avoidance of additional soft-tissue dissection. But intramedullary nailing also causes different complications, like primary and secondary mal-alignment, malunion, delayed healing and non-healing of tibial metaphyseal fractures. Several nailing methods and reduction techniques have been developed to minimize these complications. The improvements of nailing methods and reduction techniques of intramedullary nailing were reviewed.