A total of 30 adults with distal third tibia fracture and same-level or more fibula fracture patients who underwent tibial load-sharing reamed intramedullary nailing were randomized into receiving operative fibular plating or nonoperative treatment of the fibular fracture. Outcomes of interest included pain on a Visual Analogue Scale (VAS), Short Form 36 Health Survey Questionnaire (SF-36), the Ankle-Hindfoot Scale, Hospital for Special Surgery (HSS) Knee Disability Scale, incidence of fracture healing, incidence of tibial alignment, and incidence of adverse events. No statistically significant differences were found between treatment groups in VAS pain scores at any follow-up period. The rate of tibial union higher in the plating group compared to the conservative group (92.3% vs. 76.9%), and a higher rate of malalignment was reported in the non-operative group. Operative time was statistically significantly longer in the plating group compared to the conservative group (p=0.002). The time to pass the tibial guidewire was statistically significantly shorter in the plating group compared to the conservative group (p=0.01).