Bleeker NJ, van de Wall BJM, IJpma FFA, et al. - This study was undertaken to compare plate fixation with nailing in terms of the operation time, non-union, time-to-union, mal-union, infection, subsequent re-interventions, and functional outcomes (quality of life scores, knee- and ankle scores). Researchers carried out to search in PubMed/Embase/CINAHL/CENTRAL for all study designs comparing plate fixation with intramedullary nailing. The analysis examined a sum of 15 studies with 1,332 patients, including ten RCTs ( n = 873) and five observational studies ( n = 459). For distal extra-articular tibia fractures, satisfactory results can be obtained with both plate fixation and nailing. Nevertheless, nailing is correlated with higher rates of mal-union and anterior knee pain while plate fixation results in an elevated risk of infection. This research serves as a guideline towards a personalized approach and facilitates shared decision-making in the surgical treatment of distal extra-articular tibia fractures. To minimize the risk of complications, the definitive treatment should be case-based and aligned to patient-specific needs.