40 patients with extra-articular distal tibia fractures were randomized to receive either Ilizarov external fixation (IE), or conventional plate osteosynthesis (PO) as treatment. The purpose of this study was to compare clinical, functional, and radiographic outcomes of these two procedures. The results of this study indicated that Ilizarov external fixation resulted in superior outcomes compared to plate osteosynthesis, with no cases of delayed union or nonunion. Patients in the Ilizarov group were also able to immediately bear weight, and this treatment resulted in a shorter time to union. These results should be interpreted with caution as this trial used a small sample size, an infrequently used outcome measure, and experience with plate osteosynthesis may have been limited. Further high-quality trials are recommended.