Open tibia fractures are associated with an increased risk of infection, delayed union, non-union and wound complications. Management is aimed at mitigating the risk of infection while optimising the biological and biomechanical environment to encourage soft tissue and bone healing. With ongoing clinical trials and research, our knowledge around best clinical practice continues to evolve. Multiple consensus documents and protocols have been formulated, yet some controversy exists around the ideal management for high risk grade III injuries. Early antibiotic therapy has become a cornerstone in the management of these injuries. However, some controversy remains around the type and duration of antibiotic therapy. Emergent debridement and lavage is a critical factor in treatment success. Intramedullary nailing is a viable fixation option for most open tibia fractures while circular external fixation has gained prominence in the management of high energy grade III injuries, especially in the presence of bone and soft tissue loss. The timing of the various treatment interventions continues to provoke debate and controversy. Considering the available literature, the local context needs to be considered. Inadequate access to theatre, shortage of staff, resources and expertise are frequently encountered. We aim to elucidate current literature with regard to the management of open tibia fractures guided in part by various consensus documents and protocols.