of the tibia, 288 cases showed spiral fractures of the tibia, which bined with PMFs in 28 cases, the PMF incidence was 9.7% . However, in our prospective study, 30 (88.2%) of 34 fractures of the tibia bined with the PMFs . Plain radiographs are often insuf ? cient for detecting posterior malleolus fractures in conjunction with ipsilateral distal third diaphyseal tibia fractures. Using a preoperative CT protocol for tibial shaft fractures can signi ? cantly improve the ability to diagnose associated intra- articular fractures that may not be evident on plain radiographs. Knowledge of these associated intra- articular fractures may prompt fracture stabilization and can prevent displacement during intramedullary nailing of tibia shaft fractures.