Distal tibial fractures, accounting for approximately 7–10% of lower-limb long-bone injuries 1, present a significant therapeutic challenge. The subcutaneous anteromedial surface of the tibia predisposes these fractures to associated soft-tissue compromise, complicating surgical management 2. Open reduction and internal fixation (ORIF), while providing direct anatomical reduction, historically carries substantial risks of infection, delayed union, and malunion, largely attributable to extensive periosteal disruption and wound-healing complications 3, 4.
 
In response, minimally invasive plate osteosynthesis (MIPO) has been developed as a biologically favorable alternative. This technique aims to preserve 
 
the fracture hematoma and local vascularity by minimizing soft-tissue dissection and periosteal stripping, thereby enhancing conditions for indirect bone healing and reducing iatrogenic soft-tissue injury5,6. Despite its theoretical advantages, a primary critique of MIPO is the potential for malalignment and articular incongruity due to the lack of direct fracture site visualization 7.
 
Current evidence on the efficacy of MIPO for distal tibial fractures remains inconsistent, with varying reports on union rates, functional recovery, and complication profiles. This study therefore aims to evaluate the clinical and radiographic outcomes of a consecutive series of distal tibial fractures treated with MIPO, with specific focus on time to union, incidence of malalignment, functional scores, and postoperative soft-tissue complications.