Comparative Study Between Minimally Invasive Plate Osteosynthesis and Distal Tip Locking Tibial Nailing in the...

Distal third tibial shaft fractures are challenging due to limited soft tissue coverage and poor vascularity. We compared minimally invasive plate osteosynthesis (MIPO) with distal tip-locking intramedullary nailing.

A prospective two-center cohort of 40 adults with extra-articular distal third tibial fractures was allocated to MIPO (n = 20) or intramedullary nailing (IMN) (n = 20). Primary outcomes were time to union and six-month functional results (AOFAS). Secondary outcomes included infections, malalignment, and secondary procedures.

Mean age was similar (MIPO 35.22 ± 5.53 years; IMN 35.52 ± 5.90). Sex distribution was as follows: MIPO 15 (75%) men and five (25%) women; IMN 14 (70%) men and six (30%) women. Union was faster with IMN (14 ± 2.5 weeks) than with MIPO (17 ± 4 weeks). AOFAS at six months showed that in the MIPO group, 12 (60%) were excellent, six (30%) were good, and two (10%) were fair. In the IMN group, 14 (70%) were excellent, four (20%) were good, and two (10%) were fair. Superficial infection occurred in four (20%) in the MIPO group versus three (15%) in the IMN group; no infection occurred in 16 (80%) in the MIPO group versus 17 (85%) in the IMN group. Malalignment occurred in one (5%) in the MIPO group versus three (15%) in the IMN group. Secondary procedures in the MIPO group included one (5%) revision and three (15%) debridements, with 16 (80%) requiring none. In the IMN group, two (10%) required dynamization, and 18 (90%) required no additional procedure.

For extra-articular distal third tibial fractures, IMN achieved faster union and a higher proportion of excellent AOFAS outcomes, with similar low rates of complications, whereas MIPO showed a lower malalignment rate. Both techniques are viable, with IMN favored when earlier union is prioritized.