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Background: Fracture of the tibia shaft accounts for 17% of lower extremity fractures, with concurrent fibula fracture in about 78% of these cases. Intramedullary fixation for fibula fractures can restore fibula alignment and thus facilitate fracture reduction, especially in cases with comminuted shaft or distal metaphyseal tibia fractures. Methods: Patients who had internal fixation of comminuted tibia shaft or distal metaphyseal tibia fracture and a concurrent fibular fracture treated with intramedullary Steinman pin fixation were included in this study. Patients' demographic data and fracture patterns were analyzed retrospectively. Postoperative X-rays were used for fracture union evaluation and alignment analysis. Results: Nine males and one female were included in the present study. Tibia fractures were classified as four OTA42 and as six OTA43, including one type I, two type II, one type IIIA, and three type IIIB open fractures. Intramedullary nail and locking plate were used as definitive fixation in four and six cases, respectively. Complications required additional surgeries including wound debridement for one patient, bone graft for three patients, and revision surgery from a broken plate to an intramedullary nail for one patient. A total of 14 fibula fractures were identified in ten patients due to four segmental fractures. Eight were Weber type C, one was Weber type B, and five were midshaft fractures. The mean duration of fibula fracture healing according to radiographs was 6.9 months. Conclusions: This study suggests that intramedullary Steinmann pin fixation for concurrent fibula fracture is a critical procedure when dealing with comminuted shaft or distal metaphyseal tibia fractures.