Outcomes of patients treated with minimally invasive plate osteosynthesis in the management of distal tibial fractures


  • Prateek Singh Randhawa Department of Orthopaedics, Bharati Hospital and Medical Research Center, Pune, Maharashtra, India
  • Gururaj Joshi Department of Orthopaedics, Bharati Hospital and Medical Research Center, Pune, Maharashtra, India
  • Pratik Ajay Mankar Department of Orthopaedics, Bharati Hospital and Medical Research Center, Pune, Maharashtra, India




Distal tibial fractures, MIPO, AOFAS score


Background: Distal tibial fractures are a common injury, often caused by high-energy trauma, and can result in significant morbidity. Traditional surgical management with open reduction internal fixation (ORIF) is associated with complications including infection and soft tissue injury. Minimally invasive plate osteosynthesis (MIPO) has emerged as a potential alternative, with advantages including less soft tissue injury and a faster return to function.  The study aimed to evaluate the outcomes of MIPO for distal tibial fractures.

Method: Sample size of 38 patients between 18-80 years of age with distal tibial fractures treated with MIPO was included. Patient demographics, fracture characteristics, surgical details and postop outcomes collected.

Results: A total of 38 patients with distal tibia fractures with a mean age of 44.36 years were included in the study. The mean duration of hospital stay was 12.71 days, and the time required for a union was 18.61 weeks. The AOFAS score improved significantly from 3 to 6 months after surgery. However, 15 patients (34.88%) reported complications, with deep infection and skin necrosis being the most common. Out of 43 patients, 11 underwent culture and sensitivity testing, with no growth in 5 cases, and the remaining cases showed various bacterial infections. Seven patients underwent implant removal due to complications.

Conclusions: The study provides valuable information about the use of MIPO in treating distal tibia fractures, as well as the risk of complications associated with this approach.


Bonkar SK, Marshall JL. Unilateral external fixation for severe pilon fractures. Foot Ankle. 1993;14:57e64.

Anglen JO. Early outcome of hybrid external fixation for fracture of the distal tibia. J Orthop Trauma. 1999;13:92e97.

Pugh KJ, Wolinsky PR, McAndrew MP, Johnson KD. Tibial pilon fractures: a comparison of treatment methods. J Trauma. 1999;47:937e941.

Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res. 1993;292:108e117.

Wrysch B, McFerran MA, McAndrew M. Operative treatment of fractures of the tibial plafond. A randomised, prospective study. J Bone Jt Surg Am. 1996;78:1646e1667

Dillin L, Slabaugh P. Delayed wound healing, infection and nonunion following open reduction and internal fixation of tibial plafond fractures. J Trauma. 1986; 26(12):1116-9.

Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma. 2010;24:24-9.

Borrelli J Jr, Prickett W, Song E. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma. 2002;16:691-5.

Kariya A, Jain P, Patond K, Mundra A. Outcome and complications of distal tibia fractures treated with intramedullary nails versus minimally invasive plate osteosynthesis and the role of fibula fixation. Eur J Orthop Surg Traumatol. 2020;30(8):1487-98.

Hooper GJ, Keddell RG, Penny ID. Conservative management or closed nailing for tibial shaft fractures. A randomised prospective trial. J Bone Jt Surg Br. 1991;73(1):83-5.

Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P et al. Distal tibia fractures: management and complications of 101 cases. Int Orthop. 2010;34(4):583-8.

Pollak AN, McCarthy ML, Bess RS, Agel J, Swiontkowski MF. Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg Am. 2003;85-A:1893-900.

McFerran MA, Smith SW, Boulas HJ, Schwartz HS. Complications encountered in the treatment of pilon fractures. J Orthop Trauma. 1992;6:195-200.

Cheng W, Li Y, Manyi W. Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis versus open reduction and internal fxation. Int Orthop. 2011;35(5):737-42.

Shobha HP, Karthik S, Dhanda A, Lingaraju K, Kumar G. Functional and radiological outcome of surgical treatment of distal tibial fracture by minimally invasive percutaneous plate osteosynthesis technique. Int J Res Orthop. 2020;6:340-4.

Singh P, Ghani A, Singh SP, Singh A. Clinico-radiological and functional outcomes of distal tibia extra-articular fractures (AO 43A1-A3) managed by minimal invasive plate osteosynthesis in a tertiary care hospital: a series of 21 patients. Int J Res Orthop. 2021;7:497-501.

Maffulli N, Toms AD, McMurtie A, Oliva F. Percutaneous plating of distal tibial fractures. Int Orthop. 2004;28(3):159-62.

Vidović D, Matejčić A, Ivica M, Jurišić D, Elabjer E, Bakota B. Minimally-invasive plate osteosynthesis in distal tibial fractures: Results and complications. Injury. 2015;46(6):S96-9.

Lakhotia D, Sharma G, Khatri K, Kumar GN, Sharma V, Farooque K. Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications. Chin J Traumatol. 2016;19(1):39-44.

Lambotte A. L’intervention operatoire dans les fractures récentes et anciennes, Paris. Maloine. 1907

Helfet DL, Shonnard PY, Levine D, Borrelli J Jr. Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury. 1997;28(1):A42-7.

Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop. 2008;32(5):697-703.

Borg T, Larsson S, Lindsjö U. Percutaneous plating of distal tibial fractures. Preliminary results in 21 patients. Injury. 2004;35(6):608-14.






Original Research Articles