Background: Fracture of the tibia is the most critical type due to its subcutaneous position in the leg, and poor soft tissue around it. Fracture of the lower third tibia represents 6% of all fractures of the whole body. It can be treated surgically by plating or external fixation technique which provide immediate weight bearing and can be considered as a primary and a definitive fixation.

The aim of the study was to compare the clinical results of both techniques for treating distal tibia fractures.

Patients and Methods: This is an interventional clinical study that was conducted on patients with either distal one third tibia fractures at Orthopedic Surgery Department at Zagazig University Hospital. 24 cases were included as a comprehensive sample, 12 cases in each group.

Results: There was statistically significant difference between external fixation and plate groups as regard lateral distal tibia mal alignment (p<0.05) being higher in external fixation group, and there was statistically significant difference between external fixation and plate groups as regard Osteoarthritis OARSI (p<0.05).

Conclusion: There was no significant difference between external fixation and plate groups as regard pain and functional outcome. Duration to radiologic union was longer in external fixation group than the plate group.