These are complex fractures with several irregular intermediate fragments involving 4 cm or more (extensive shattering) of the tibial diaphysis. These are the most serious of the tibial fractures. Although the center of the fracture site is in the diaphysis, the fracture line often extends to the metaphyseal-epiphyseal segments. These fractures are classified as AO/OTA 42C3 fractures. Since these are high-energy fractures, they are often associated with soft tissue damage, which may influence the treatment options.