12 randomized controlled trials comparing reamed and unreamed intramedullary nailing for tibial fractures were included in this meta-analysis. Clinical outcome variables were assessed in hopes of determining the optimal treatment method for open and closed tibial fractures. A significantly higher rate of fixation failure was observed in the unreamed group compared to the reamed group in closed fractures, but all other findings were similar between nailing groups. Results from this meta-analysis indicate that further trials are required to establish a favorable technique in the treatment of open tibial fractures.