BackgroundTibial fractures with an associated vascular injury are a challenging management problem for the orthopedic and vascular surgeon. The effect of a concomitant vascular injury on fracture healing has not been specifically delineated previously.MethodsWe performed a retrospective review of 29 fractures of the tibial shaft with an associated vascular injury in 28 patients.ResultsOverall there were 44 vessels injured (38 arterial and six venous). A total of six patients had an amputation performed; patients requiring amputation were significantly older than those without amputation. Fractures with an associated injury to the posterior tibial artery had a significantly higher nonunion rate and a greater number of weeks to union than fractures without this vascular injury.ConclusionOutcomes of tibial fractures with an associated vascular injury are poorest in older patients (who are at increased risk of amputation) and those with an injury to the posterior tibial artery (who are at increased risk of delayed union and nonunion).