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OBJECTIVES To assess the ability of computed tomographic angiography (CTA) identified infrapopliteal vascular injury to predict complications in tibia fractures that do not require vascular surgical intervention. DESIGN Multicenter retrospective review. SETTING Six Level I trauma centers. PATIENTS AND INTERVENTION 274 patients with tibia fractures (OTA/AO 42 or 43) who underwent CTA, maintained a clinically perfused foot not requiring vascular surgical intervention, and were treated with an intramedullary nail. Patients were grouped by the number of vessels below the trifurcation that were injured. MAIN OUTCOME MEASUREMENTS Rates of superficial and deep infection, amputation, unplanned reoperation to promote bone healing (nonunion), and any unplanned reoperation. RESULTS There were 142 fractures in the control (no-injury) group, 87 in the one-vessel injury group, and 45 in the two-vessel injury group. Average follow-up was two years. Significantly higher rates of nerve injury and flap coverage after wound breakdown were observed in the two-vessel injury group. The two-vessel injury group had higher rates of deep infection (35.6% vs. 16.9%, P=0.030) and unplanned reoperation to promote bone healing (44.4% vs. 23.9%, P=0.019) compared to controls, as well as increased rates of any unplanned reoperation compared to control and one-vessel injury groups (71.1% vs. 39.4% and 51.7%, P<0.001), respectively. There were no significant differences in rates of superficial infection or amputation. CONCLUSION Tibia fractures with two-vessel injuries were associated with higher rates of deep infection and unplanned reoperation to promote bone healing compared to those without vascular injury, as well as increased rates of any unplanned reoperation compared to controls and fractures with one-vessel injury. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.