Objective To explore the therapeutic effect and advantage of self-made hollow instrument to get into and obtain bone in the proximal tibial and transplace the bone into the place of tibial middle and lower fractures undergoing intramedullary nailing fixing.Methods The clinical data of 36 cases of the tibial middle and lower fractures were analyzed retrospectively.All of the patients were treated to get into and obtain bone in the proximal tibial with the self-made hollow instrument,and transplace the bone into the place of tibial middle and lower fractures undergoing intramedullary nailing fixing.Results All patients were followed up from 8 to 16 months.The tibial middle and lower fractures were healed from 4 to 7 months.According to Johner-Wruhs clinical grading system,31 cases were excellent,5 cases were good.Conclusion Using self-made hollow instrument to get into and obtain bone in the proximal tibial,and transplace the bone into the place of tibial middle and lower fractures undergoing intramedullary nailing fixing,has more advantages,including avoiding to obtain bone from ilium and transplance the bone in the two periods,more reliable repaired bone gap and improve the heal rate of the tibial middle and lower fractures.So the self-made hollow instrument to get into and obtain bone in the proximal tibial should be promoted with clinical application.