Abstract: Objective To study surgical outcomes of A-type tibial shaft fracture and incidences of combined ankle injury. Methods Clinical data about 189 patients with A-type tibial shaft fracture admitted to our hospital from October 2012 to October 2016 were retrospectively analyzed. Patients were divided into three groups according to the morphology of fracture line, group A with spiral fracture (n=70), group B with oblique fracture (n=58) and group C with transverse fracture (n=61). All patients had undergone closed reduction and intramedullary nailing. The operating time, average length of hospital stay, surgical outcome, incidence of combined ankle injury and misdiagnosis by X-ray in three groups were analyzed and compared. Results All patients were followed up at 6 weeks, 3 months, 12 months after operation. There was no significant difference in gender and age between three groups(all P> 0.05). The incidence of ankle injury in A-type tibial shaft fracture was 38.6% in group A (12 cases of posterior malleolar fracture, 8 cases of distal tibiofibular syndesmosis injury, 4 cases of medial malleolar fracture and 3 cases of laternal malleolar fracture), 10.3% in group B (3 cases of medial malleolar fracture and 3 cases of laternal malleolar fracture), and 13.1% in group C(4 cases of medial malleolar fracture, 3 cases of laternal malleolar fracture and 1 case of posterior malleolar fracture). The number of patients with ankle injury in group A was significantly more than the other two groups (all P< 0.05). The number of patients with ankle injury misdiagnosed by X-ray in group A was 12, 1 in group B and 2 in group C, and the difference between three groups was significant (all P< 0.05). And the average length of hospital stay and operating time in group A were significantly greater than those in the other two groups(18.63±3.39) d vs (15.26±2.71) d and (14.40±3.52) d; (78.93±12.46) min vs (66.43±15.09) min and (64.76±10.37) min; P< 0.05, respectively. According to Johner-Wruhs Criteria, the excellent and good rate in group A was 92.8%, 93.1% in group B and 93.4% in group C at 12 months after operation, without significant difference. Conclusion Patients with A-type tibial shaft fracture achieve favorite outcomes by surgical treatment. Ankle injuries commonly occur in the spiral tibial fracture due to the special mechanism of violent injury, and occult fracture around the ankle joint are easily overlooked.