Background: The distal 1/3rd shaft tibia extra-articular fractures are treated with both tip locking intra-medullary nailing (TLIMN) and precontoured anatomical locking plates (PCALP). The aim of this study was to compare the results of TLIMN and PCALP in distal tibia fractures and to determine dominant strategies. The complications and functional outcome in both groups were compared. Methods: Forty patients with distal 1/3rd shaft tibia were randomly assigned to TLIMN (group 1) and PCALP group (group 2). The functional outcomes were evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score. Complications like infection, delayed union, non-union, malunion, hardware prominence and secondary interventions were compared. Results: The average union time was 15.05±3.33 weeks in group 1 and 13.4±2.46 weeks in group 2 (p=0.045). The mean AOFAS score at 1 year follow up was 89.8±6.13 in group 1 and 89.1±6.15 in group 2 (p=0.262). Five patients in group 1 and one in group 2 had mal-alignment. Deep infection was present in one and superficial infection was present in two cases in group 2. Four patients in group 1 developed anterior knee pain and five patients in group 2 had hardware prominence. Conclusions: We conclude that tip locking intra-medullary nail is a reliable and satisfactory method for treatment of fractures of distal 1/3rd shaft tibia AO type 42A, 42B and 42C fractures with good functional outcomes and high union rates with comparatively low complications. Prevalence of malunion was higher in TLIMN group and hardware prominence was more prevalent in PCALP group. Implant removal are more in PCALP group mostly due to implant irritation.