Background: Tibial fractures are most common fractures encountered in road traffic accidents due to its location. The aim of treating tibial fractures is to provide functionally useful and stable extremity. Among various treatments interlocking intramedullary nailing proves to be good.

Methods: In this study to highlight the role of interlocking intramedullary nailing by patellar tendon splitting approach in the management of unstable fractures of tibia, we have enrolled all the tibia fractures admitted in the orthopedics department in the time period of January 2016 to December 2016. It is prospective study.

Results: Among the patients studied 95% were male patients, one was female [50%]. Road traffic accidents were the common mode of injury (65%), with fall (25%) and assault (10%) next in frequency. Right leg was found to be more prone for injury(80%). Middle third fractures (65%) contributed to maximum number of fractures.

Oblique (40%) and communited (20%) fractures were found in majority of cases. We followed anatomical and unstable fracture classification in our study. Majority of the cases were operated within 2 weeks of injury. Average duration between injury and operation is 9.5 days in our series. All cases were operated under spinal anesthesia over a simple radiolucent table with leg hanging by the side or by using wooden bolster or by bringing the patient at the edge of table. Tourniquet was used for all the cases. Our study included 95% closed fractures, which healed in a mean time of 16.4 wks while open fracture (Grade I) united at an average duration of 20 wks. There were 4 cases with associated fractures. One patient had Ipsilateral open fracture femur with both bones leg lower third. Two of our patients had associated tibia1 plateau and fracture both bones in another leg. one patient had pelvic fracture. All patients were mobilized as early as possible, and weight bearing was started depending on callus formation. Per operatively we had difficulty in distal locking in two patients. 95% of the patients were locked in static mode. 90% of cases united normally and one had delayed union. Average duration for union in our study was 17 weeks.

Conclusion: Intramedullary interlocking nailing by medial entry point by retracting patellar tendon laterally has good functional outcome, low complication, early recovery when compared to other methods in stabilization of unstable tibial fractures.