Background: Physeal fractures of long bones are common injuries treated by orthopedists. Distal tibial physeal fractures account for 11% of all physeal injuries. Objectives: The aim of the work is evaluation of the clinical and radiological outcome of lower tibial epiphyseal injury managed by percutaneous pinning. Patients and Methods: This was a prospective randomized study carried out on 12 cases with distal tibial epiphyseal injuries admitted to Zagazig University with follow up period up to six months. The youngest patient was 8 years old, while the oldest was 16 years old, with an average of 12 years; the high incidence was in the age group 10-15 years. Results:Overall results obtained from 12 cases were satisfactory in 11 cases (91.66%) and unsatisfactory in 1 cases (8.37%). More satisfactory results in this work were in the age group 10-15 years. However, age did not affect the results significantly. Cases with closed injury showed more satisfactory results (100%) than those with open injury, the difference was statistically highly significant. All cases in this study were presented within the first 48 hours from onset of trauma. 8 cases were immobilized for 8 weeks and 4 cases for 6 weeks. The difference was statistically insignificant. 2 cases were managed by open reduction and internal fixation and the difference was statistically insignificant. Conclusion: The percutaneous pinning for lower tibial epiphyseal injury showed good reduction of fracture, satisfactory functional outcome and less complications. The technique provided speed recovery, secure fixation and avoiding prolonged cast immobilization and conservative treatment.