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The aim of this randomized control trial is to examine the clinical outcomes for distal tibial fractures managed with IMN compared to those managed with plate fixation, to further elucidate the most optimum management. This was a multicentre randomized controlled trial recruited patients 18 years and older sustaining a closed, isolated extra-articular distal tibial fracture from 16/10/2015 to 20/03/2019. Open fractures, polytrauma or too distal fracture to achieve fixation of four cortices with distal interlocking screws for intra-medu