To determine the possible relationship between outcome and fixation method for tibial fractures associated with compartment syndrome, the authors retrospectively reviewed the records of 96 patients (average age, 31.8 years) with this injury. Seventy-eight patients had multiple injuries (average Injury Severity Score, 22.37). There were 68 closed and 28 open fractures, including 3 gunshot wounds. Compartment syndrome was diagnosed by direct measurement or by clinical findings. The attending surgeon selected the type of fixation based on fracture pattern and associated injuries. Time to healing for the 96 fractures averaged 31.6 weeks. There was no significant difference in healing times between open and closed fractures or between methods of treatment. Healing time for closed fractures was significantly different from that reported for closed fractures not associated with compartment syndrome (30.2 compared with 17.3 weeks, respectively; open fracture healing times were not significantly different (35 compared with 29.3 weeks, respectively). The authors conclude that (1) compartment syndrome significantly lengthens the time to healing for closed tibial fractures but does not significantly affect the time to healing for open tibial fractures; (2) closed tibial fractures with compartment syndrome appear to act as open fractures; and (3) the method of fixation does not appear to affect time to healing for closed or open fractures associated with compartment syndrome.