Fractures of the tibia can be managed by Surgical Implant Generation Network intramedullary nail system in developing countries. The entry point is an important aspect of achieving accurate restoration of alignment. The fracture site should not be nailed in a distracted position. If distraction is observed, back-slapping the nail will improve bone apposition. If fluoroscopy is not used for the procedure, and the fracture site is noted to be distracted on post-operative x-rays, either revision surgery or early nail dynamization should be considered. Blocking (Poller) screws can be very helpful for proximal or distal tibial fracture management. Definitive wound closure of open fracture wounds should be achieved as soon as possible after the initial debridement surgery usually by 3 to 7 days. Leave grossly contaminated wounds open and covered with an antibiotic bead pouch if in doubt and perform repeat debridement 24 to 36 hours later. Segmental bone loss can be managed most commonly by autogenous iliac crest bone grafting although more sophisticated techniques such as bone transport are occasionally required.