Distal tibial fractures present a therapeutic challenge due to limited soft-tissue coverage and the need to achieve stable fixation while preserving local vascularity. Minimally invasive plate osteosynthesis (MIPO) has emerged as a biologically favorable technique for managing selected extra-articular distal tibial fractures by minimizing soft-tissue disruption and maintaining fracture hematoma. This case series describes three patients with right-sided closed extra-articular distal tibial fractures classified as AO Foundation/Orthopaedic Trauma Association (AO/OTA) 43-A1.2, managed with MIPO using a medial distal tibial locking plate with supplementary fibular fixation. All patients underwent early definitive fixation within hours of injury following initial stabilization. Postoperative protocols included staged weight-bearing progression guided by radiographic healing. All cases demonstrated satisfactory reduction and maintained alignment throughout follow-up, with progressive callus formation and eventual fracture union. No wound complications, implant failure, malalignment, or reoperation were observed. Functional outcomes were favorable, with good to excellent ankle function in all patients and American Orthopaedic Foot & Ankle Society (AOFAS) scores of 90 and 85 in the assessed cases. This series highlights that MIPO is an effective and reliable treatment option for selected extra-articular distal tibial fractures, providing stable fixation, preservation of fracture biology, and satisfactory clinical and radiographic outcomes when appropriate patient selection and surgical technique are applied.
Sulaiman et al. (Wed,) studied this question.