321 patients with a displaced, extra-articular distal tibial fracture were randomized to fixation with either an intramedullary nail or a locking plate. Patients were followed up for the primary outcome of disability at 3, 6, and 12 months, secondary outcomes included function, quality of life, complication rate, and reoperation rate. For disability, significantly lower scores were observed in the IMN group compared to the LP group at 3 months, though differences at 6 and 12 months were not statistically significant. For function, significantly high scores were observed in the IMN group compared to the LP group at 3 and 6 months, but the difference at 12 months was not significant. Rates of complications and reoperations did not significantly differ between groups during follow-up.