Abstract: Objective To improve the accuracy and efficiency of the distal tibial locking nail placement by improving the interlocking intramedullary nail positioning apparatus. Methods Total 37 cases of tibial fractures undergoing internal fixation with interlocking intramedullary nailing in our hospital from March, 2006 to August, 2016 were selected. There were 26 males and 11 females aged 20 to 71 years old, with an average age of 46.2 years. There were 15 cases of left tibia fracture and 22 cases of right tibial fracture. All operations were performed by the same surgeon. The improved positioning instruments were used to help determine the distal locking hole. The time and success rate of locking nails were recorded. Statistical methods were used to judge statistically significant. Results All the subjects were successfully placed in a total of 74 distal locking nails, 30 on the left and 44 on the right. The success rate of two screws was 98.7% and the success rate of the second remote locking nail was 100%. The success rate has been significantly increased (no cases failed with two or more times of locking nails). The average use time of locking the first distal lock was 5.5 min, and the average time required to lock in the second lock was 3.2 min, two screws were used within 4-15 min and the average time was 8.7 min. The time of the lock was significantly less than the time before the improvement. Conclusion The modified location pressure bar can significantly improve the accuracy of interlocking intramedullary nail distal locking, reduce the operative time and improve the quality of operation, and it has the advantages of economical and low cost. It is suitable for popularization and application in primary hospitals.