Open tibia fractures in children comprise only 2–3% of all fractures yet they account for one-third of open fractures that occur in this age group. Basic management principles are similar to those used to care for adults with open tibia fractures. Careful assessment of the child to rule out associated injuries, determination of soft tissue and neurovascular status of the fractured limb, administration of antibiotics in the Emergency room, and thorough irrigation and debridement in the operating room are keys to achieving good outcomes. While cast immobilization is an option for some open fractures, fixation is utilized for many open fractures. Flexible intramedullary nails, external fixation, percutaneous wire fixation, and plate-screw constructs are all effective in stabilizing these fractures and are selected based on age and the size of the child and the specifics of the injury.