PURPOSE : To compare redioiogic results between interlocking intramedullary nail with fibular fixation and nail only for treating distal tibiofibular diaphyseal fractures. MATERIALS AND METHODS : From April 1993 to February 1999, 26 distal tibiofibular fractures were antegrade nailed after anatomical reduction and fixation of fibular fractures, and another 61 fractures fixed with nails only. Average age of patients was 41.8 years. These two groups were compared by frequency of malalignment, degree of postoperative angulation, angulation according to comminution, angulation according to fracture configuration. The statistical analysis was evaluated by t-test. RESULTS : Fibular fixation group had no malalignment while non-fixations had angulation of 1.2+/-1.1 degree and non-fixation had 3.0+/-2.1. So fixation had lessor angulation than non-fixation significantly(p=0.004). In lateral rediographs, each had 1.3+/- 1.1, 2.8+/-2.3 degree and showed significant difference(p=0.027). In type I and II fractures of Winquist-Hansen classification, fixation group showed lesser degree of angulation in A-P plane significantly(p=0.008) but no significant difference in lateral plane. In type III and IV, no significant difference in both planes. According to configuration of fractures, transverse and spiral fractures showed no significant differences but oblique configurations had significant differences in A-P plane(p=0.002) CONCLUSION : Interlocking intramedullary nail with fibular fixation has the advantage in maintenance of alignment during insertion of nail in distal tibiofibular fractures, especially in Winquist-Hansen classification type I and II and oblique fractures in anteroposterior plane, so it can be a worthy method for the treatment of distal tibiofibular diaphyseal fractures.