Lower leg injuries are increasingly common in motor vehicle crashes accounting for 32% of all AIS2+ injuries. Distal tibia fractures have disproportionately poor clinical outcomes and subsequently affect a patient’s ability to perform daily walking activities. Previous studies have identified trends suggesting that females are at increased risk of lower leg injuries. Therefore, the objective of this study is to quantify the relationship between sex and distal tibia fractures. The Crash Investigation Sampling System (CISS) is a nationally representative sample of police-reported, passenger vehicle, tow-away crashes. Accounting for the CISS sampling scheme, a logistic model was constructed to estimate the likelihood of distal tibia fracture while controlling for the occupant sex, age, belt use, and delta-v. Unbelted occupants, crashes at higher delta-v, and occupants older than 55 years were at higher risk of distal tibia fracture. All injuries were caused by interaction between the toe panel or foot controls and the occupant’s leg. An increased injury risk for females was found, but did not reach statistical significance due to small sample size. Given that this trend has been shown in a number of other studies, continued research into sex-related differences in injury risk with larger sample sizes is needed.