Acute compartment syndrome is a serious complication to tibial fractures. The reported incidence is 1-10%. The present series includes 60 patients treated with intramedullary nailing of fractures in the tibial diaphysis. Tissue pressure was measured in 31 patients. Decompressive fasciotomy was performed if the pressure exceeded 30 mm Hg for more than 30 minutes. Follow-up showed no patients with clinical sequelae from a compartment syndrome, but the incidence of fasciotomy was as high as 18%.