Eight randomized controlled trials were included in this meta-analysis which compared surgical and radiographic outcomes between intramedullary nail fixation and locking plate fixation for distal tibial fractures. Pooled analyses which demonstrate a significant difference between groups included a lower incidence of wound healing problems and shorter operative time among IMN groups compared to locking plate groups. Analyses on time to union and incidence of delayed union/nonunion demonstrated no statistically significant differences between treatment options.