The goal of this thesis is to understand the incidence of tibia fractures, the incidence of rotational malalignment of the tibia after intramedullary nailing and functional impact of this postoperative malrotation. Tibia fractures have a high incidence with a huge social and economic impact, which can interfere with our daily activities. The rotational malalignment after treatment could have a negative functional outcome with even the need for revision surgery as a result. The aim of this study is to identify this incidence as well as the functional impact. This by using the currently available literature. Tibia fractures are often treated with intramedullary nailing. A common disadvantage of this technique is the possibility of rotational malalignment as a complication. Our systematic review explored studies from 2003-2024 to understand how common rotational malalignment is and its impact on patients. We analysed data on 889 patients with tibia fractures who underwent intramedullary nailing. We found that roughly 25% of the patients suffered some degree of rotational malalignment. A distribution of these cases of rotational malalignment was made for the severity of malrotation, the direction of malrotation, the fracture location and the grade of the fracture. Interestingly, while rotational malalignment could influence the functional performances of the patients, very few literature have studied this. That’s why the impact on patients remains inconclusive until this point. The findings of our systematic review emphasize the importance of continued search into the functional impact on patients.