Background: The study was conducted with the aim to evaluate the management of distal tibial fractures with IM nailing, external fixator and MIPO and determine which one is optimal for each individual patient. Methods: A total of 60 patients were treated for distal tibial fracture using different modalities according to the fracture pattern and skin condition. Clinical, functional and radiological evaluation was done for each modality. Patients were assessed for complications like ankle stiffness, wound discharge, non-union at each follow up. Results: The mean AOFAS score was highest in the patients treated with MIPO followed by IM nailing and External Fixator and the difference was statistically significant. Most of the complications were found in the patients treated with External Fixator followed by MIPO and IM nailing. And most number of varus and valgus deformities were found in the patients treated with External Fixator and IM nailing and least in the patients treated with MIPO. Conclusion: MIPO was a better treatment modality than IM nailing and External fixator from clinical, functional and radiological perspectives.