Ten RCTs with a total of 911 patients were included in this meta-analysis comparing intramedullary nailing and minimally-invasive plate osteosynthesis for the treatment of distal tibia fractures. Outcomes of interest included operative time, radiation time, union time, the incidence of malunion, the incidence of non-union or delayed union, and the incidence of wound complications. Results revealed a significantly lower risk of malunion, but higher risk of wound complications, with minimally-invasive plate osteosynthesis compared to intramedullary nailing. Pooled results for remaining outcomes were not significantly different.