Aims: Outcome of the distal tibial fractures treated with interlocking nail. Method: We reviewed 108 patients with distal tibial fractures which were treated in our clinic between 1990 using interlocking intramedullary nailing. 94 patients (63 men and 31 women) were found in the recent follow up. AO fracture classiþcation system was used Seventy-eight patients had concomitant fractures of the lateral malleolar and 4 had medial malleolar fractures. Eight (8,5%) of the fractures were open grade I. All fractures were managed with closed reamed nailing. In fourteen cases the nail had to be shortened. The lateral malleolar fractures were þxed before tibial nailing to ensure overall alignment. Results: Union was achieved in 89 (94,6%) fractures with a mean time of union of 4,2 months (range:3–10 months). One deep infection (1,06%) lead to nonunion. Three aseptic cases had delay union which required nail dynamization. In one more nonunion case bone grafting and þbulectomy required. Postoperative transient peroneal palsy occurred in 2 (2,12%) patients which were fully recovered. One patient developed deep posterior compartment syndrome leading to FHL conctracture, needed tendon lengthening. Conclusions: Interlocking intramedullary nailing is a reliable, safe and effective method of managing distal tibial fractures with or without minimal ankle joint involvement.