170/321 (53%) patients with distal tibial fractures from the FixDT trial consented to participate in the 5-year follow-up study comparing intramedullary nailing (n=83) and locking plate fixation (n=87). The primary outcome of interest was the Disability Rating Index (DRI). The secondary outcomes included health-related quality of life, measured with the EQ-5D-3L and EQ-VAS scales, as well as the incidence of complications. Follow-up was conducted up to 5 years post-operation. No significant differences between the two groups were observed in all outcomes, suggesting comparable efficacy and safety between the two treatment methods over 5 years. However, the significant loss to follow-up limits the statistical power of the analysis, and there were significant baseline differences between those who responded and those who did not consent to the 5-year follow-up, particularly with respect to age, BMI, pre-injury function and health-related quality of life scores, and smoking status.