ObjectiveTo explore the effectiveness of three different operative methods in the treatment of closed fracture of the tibial shaft. MethodsBetween January 2012 and May 2014, 94 patients with closed fracture of the tibial shaft were treated, and the clinical data were retrospectively analyzed. Fracture was fixed with locking plate (external fixation) in 25 cases (group A), with intramedullary nail in 34 cases (group B), and with minimally invasive locking plate in 35 cases (group C). There was no significant difference in gender, age, reasons of injury, fracture types, and time from injury to operation among groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy frequency during operation, fracture union time, and complications were recorded. The effectiveness was evaluated according to Johner-Wruhs criteria. ResultsThe operation time and fluoroscopy frequency during operation in groups A and C were significantly less than those in group B (P<0.05), but there was no significant difference between groups A and C (P>0.05). The intraoperative blood loss in groups A and C was significantly less than that in group B (P<0.05), and the blood loss in group A was significantly less than that in group C (P<0.05). All patients were followed up 15.61 months on average (range, 12-41 months). There was no significant difference in fracture union time among 3 groups (F=1.712, P=0.186). The excellent and good rates of groups A, B, and C were 92.00%, 88.24%, and 91.43% respectively according to Johner-Wruhs criteria at 12 months after operation, showing no significant difference (χ2=0.301, P=0.860). At 12 months after operation, the complication incidences of groups A (12.00%, 3/25), and C (15.55%, 5/35) were significantly lower than that of group B (44.12%, 15/34) (P<0.017), but no significant difference was found between groups A and C (P>0.017). ConclusionUsing locking plate as external fixation and minimally invasive locking plate internal fixation are better than intramedullary nail fixation in treating closed fracture of tibial shaft because of less injury and lower complication incidence, and locking plate as external fixation is better than minimally invasive locking plate internal fixation because of less injury.