PURPOSE: To evaluate the clinical and radiographic results of interlocking intramedullary nailing for the distal metaphyseal fractures of the tibia and to identify the usefulness of the interlocking intramedullary nailing. MATERIALS AND METHODS: Thirty four patients who underwent interlocking intramedullary nailing for distal metaphyseal fractures of the tibia were reviewed with a follow-up period of more than 2 years. Clinical result was assessed using the Olerud score and this score was marked as percentage of prefracture state. Radiographic results were assessed with varus-valgus angle, anterior-posterior angle, and bone union time. We checked the cases of complication and need for additional surgery after interlocking intramedullary nailing. RESULTS: Clinically, Olerud score averaged 92.1% (76~100%). Radiographically, average varus-valgus angle was 1.6±2.9 degrees and average antero-posterior angle was 0.8±3.3 degrees. Bone union time averaged 18.7 weeks. As complications, there were one deep infection and two breakages of distal interlocking screw. In additional surgery, there were 1 debridement and soft tissue flap, and one dynamization of nail at postoperative 12 weeks. CONCLUSION: Interlocking intramedullary nailing is one of safe and reliable method for distal metaphyseal fractures of the tibia, considering less soft tissue injury, possibility of early range of motion exercise, high bone union rate, and low complications rate.