58 patients, between the ages of 18 and 75, with isolated displaced tibial shaft fractures, were randomly assigned into 1 of 2 groups to compare the efficacy of circular Ilizarov external fixator to intramedullary nailing for the fixation of tibial diaphyseal fractures. Upon study completion, healing analysis indicated that fractures in both groups healed radiographically by 12 week follow up; however, four patients in the Ilizarov fixator (IL) group compared to eight in the intramedullary nailing group sustained major complications after treatment. At 1 year, a significant difference in pain and satisfaction was found in favour of the IL group. No differences were found between groups regarding range of motion in the knee or ankle joints.