# Comparative Study Between Minimally Invasive Plate Osteosynthesis and Distal Tip Locking Tibial Nailing in the Treatment of Lower Third Tibial Shaft Fractures

## TL;DR

This study compares two surgical methods for treating lower leg fractures and finds that intramedullary nailing leads to faster healing and better outcomes.

## Contribution

The study provides a direct comparison of MIPO and IMN for distal third tibial fractures using a prospective cohort.

## Key findings

- Intramedullary nailing resulted in faster bone union compared to MIPO.
- IMN achieved a higher proportion of excellent functional outcomes at six months.
- MIPO had a lower rate of malalignment compared to IMN.

## Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.