This thesis titled ‘’optimization of management for tibia fractures: diagnostic- and surgical strategies’’ aimed to improve essential surgical aspects in definitive treatment of tibia fractures. In the first part of this thesis, a comparison of the SP-approach and IP-approach for tibia fractures was provided reporting on clinical outcomes of interest. We can conclude that both the SP- and IP-approach are reliable surgical approaches for tibia nailing without sufficient differences in rates of anterior knee pain and surgical complications as patellofemoral chondropathy, alignment errors and infection. We tried to clarify the ongoing debate with regards to definitive surgical treatment of distal fractures of the tibia. Both plate fixation and IMN are two well-established surgical modalities. In the last parts, aiming to clarify the essential aspects of RM after IMN of tibia fractures, we improved the understanding of RM. We feel that RM is an often-underestimated iatrogenic pitfall of IMN. Based on reliable post-operative low-dose CT-assessment, high incidences of RM were identified. Therefore, we designed, developed and introduced the ‘C-arm rotational view (CARV)’, a reliable and easy-to-use fluoroscopic protocol to minimize the potential of RM during IMN of tibia fractures.