Abstract: [Objective] To investigate the clinical effect of external fixation stent and intramedullary nail in the treatment of external tibial fracture. [Methods] Retrospective analysis was performed on 82 patients with distal tibial extracarticular fracture admitted to our hospital from January 2009 to January 2013. According to different treatment methods, the patients were divided into external fixation group and intramedullary nail group. External fixation bracket and intramedullary nail were used to treat external tibial fracture. The clinical data of the two groups were compared. [Results] All patients (12-24) were followed up for a mean of (15.13±3.48) months. There were statistically significant differences between the two groups in preoperative waiting time, intraoperative blood loss, walking time to the ground, time of full weight-bearing activity, and VAS score (P < 0.05). There was no significant difference in operation time or Mazur score of ankle function between the two groups (P > 0.05). There was no statistically significant difference between the two groups in the overall fracture healing time and the fracture healing time of type A and type B patients (P > 0.05). However, the fracture healing time of type C patients in the external fixation group was significantly shorter than that in the intramedullary nail group, and the difference was statistically significant (P < 0.05). At the last follow-up, 2 patients in the external fixation group had ankle pain, which was relieved after the removal of the external fixator, and 3 patients had delayed bone healing, which was healed after adjusting the external fixation strength. In 2 cases, the force line was shifted and healed after adjusting the external fixator. In the intramedullary nail group, 3 patients had knee pain. After bone healing, the intramedullary nail was removed, and the pain in the affected limb disappeared. Bone union was delayed in 2 cases, which was cured after adding weight and applying shockwave treatment. Malunion occurred in 1 case, and the patient refused the second operation.[Conclusions] The application of external fixation in the treatment of distal tibial fractures, especially in patients with poor soft tissue conditions, can reduce the preoperative waiting time. Compared with intramedullary nail, it has less damage to surrounding soft tissue and can reduce the rate of skin necrosis.