[Objective] To compare the efficacy of unilateral external fixation combined with lag screw and intramedullary nail in the treatment of tibial shaft fracture.. [Methods] From January 2016 to January 2019, the clinical data of 59 patients with tibial fracture who underwent operation in our hospital were analyzed retrospectively. Among them, 31 cases were treated with limited open reduction and unilateral external fixation combined with lag screws, 28 cases were treated with closed reduction and intramedullary nail. The data of perioperative period, follow-up and imaging were compared between the two groups. [Results] The operation time, total length of incision, intraoperative blood loss, intraoperative fluoroscopy times, walking time, hospitalization time, complete weight-bearing time, ROM of knee flexion and extension 1 month after operation, ROM of knee flexion and extension 3 months after operation, tibial alignment, fracture healing time, tibial length difference ratio of the two groups were significantly different (P < 0.05). The ROM of ankle flexion and extension, limping, squatting and excellent and good rates of Johner-wruhs scores of the two groups were compared, P > 0.05, and there was no statistical difference. [Conclusion] limited open reduction with single arm external fixator combined with lag screws in the treatment of tibial shaft fracture can obtain a functional score equivalent to that of intramedullary nail, and is superior to intramedullary nail in terms of operation time, total length of incision, intraoperative blood loss, intraoperative fluoroscopy times, early knee flexion and extension ROM, tibial alignment, fracture healing time, tibial length difference. it can be used in the treatment of tibial shaft fracture.