320 patients with a distal tibial fracture were randomized to fixation with either an intramedullary nail or a locking plate. Patients were assessed for disability and function after 3, 6, and 12 months follow-up. Complications were recorded, and economic analysis was performed. Clinical measures were reported to significantly favour intramedullary nail fixation after 3 months, though differences at 6 and 12 months were reported to not significantly differ between the two fixation types. The Economic evaluation also favoured intramedullary nail fixation.