Background: The management of the fracture of lower third tibia remains a great challenge to the surgeon. The present study was aimed to evaluate and compare the intraoperative and postoperative outcomes between plate fixation, and intramedullary nail for identifying proper indications of both methods of fixation. Patients and Method: During 2015 - 2019, 96 cases with distal tibial fractures had been treated using either M.I.P.O technique or Expert intramedullary nailing technique, in a prospective study conducted in Zagazig University Hospitals. 48 cases had been treated by M.I.P.O technique and 48 cases had been treated by Expert intramedullary nailing technique. Results: The results suggest that M.I.P.O technique was not always the best choice for all types of fractures of lower third tibia. Expert I.M.N, with less soft tissue disruption, good coronal, and sagittal alignment, was considered a standard operative treatment for diaphyseal tibial fractures. However, cases with I.M.N should follow weight-bearing restrictions until there is obvious callus formation in order to prevent malunion, broken distal screws, or propagation of nail into ankle joint. Conclusion: The study suggests that both Expert I.M nailing, and M.I.P.O. techniques were appropriate treatments of distal tibial fractures. M.I.P.O. fixation, and Expert I.M nailing were safe, and effective treatment options for fractures of lower third tibia, because both of them could provide similar good function outcomes. Expert I.M nailing must have the priority for distal tibial fractures with soft tissue injury, or fractures that occurred more than 5 cm from the tibial plafond. M.I.P.O should have the priority for distal tibial fracture with good skin condition, soft tissue condition, or fractures that occurred less than 5 cm from tibial plafond.