A Comparative Study of Management of Distal One Third Tibia Fracture by Intramedullary Interlocking Nail Versus Minimally Invasive Plate Osteosynthesis (MIPO)

Background: Distal one-third tibia fractures present significant therapeutic challenges due to subcutaneous location, precarious vascular supply, and a sparse soft-tissue envelope. Both intramedullary interlocking (IMIL) nailing and minimally invasive plate osteosynthesis (MIPO) are biological fixation strategies designed to preserve fracture biology, but controversy persists regarding their relative efficacy. This study compares the surgical, radiological, and functional outcomes of IMIL nailing versus MIPO in closed, extra-articular distal tibia fractures. Material and Methods: A prospective longitudinal study was conducted on 30 patients aged 18–60 years presenting with extra-articular distal one-third tibia fractures between December 2022 and May 2024. Patients were allocated equally into two treatment arms: Group A (IMIL nailing, n = 15) and Group B (MIPO, n = 15). Operative duration, time to union, time to full weight-bearing, complications, and final functional outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score were evaluated. Results: The mean operating time was comparable between the IMIL nailing group (94.73 \pm 5.84 minutes) and the MIPO group (95.60 \pm 4.64 minutes; p = 0.6561). Mean time to radiological union was 18.27 \pm 2.37 weeks in the IMIL group compared to 21.87 \pm 8.37 weeks in the MIPO group (p = 0.1201). Time to weight-bearing was slightly shorter in the IMIL group (9.47 \pm 1.13 weeks vs. 10.33 \pm 1.23 weeks; p = 0.0542). At final follow-up, excellent/good AOFAS scores were achieved in 86.7% (13/15) of nailing patients and 80.0% (12/15) of MIPO patients, with no statistically significant difference in functional distribution (p = 0.3871). Complication rates (superficial infection, malalignment, and delayed union) did not differ significantly between the two groups. Conclusion: Both IMIL nailing and MIPO are safe and effective modalities for managing extra-articular distal one-third tibia fractures, offering comparable union rates and functional outcomes. IMIL nailing facilitates earlier secondary bone healing and weight-bearing due to its load-sharing properties, whereas MIPO provides superior anatomical alignment control in selected fracture geometries.

Keywords: Distal tibia fracture, Intramedullary interlocking nail (IMIL), Minimally invasive plate osteosynthesis (MIPO), AOFAS score, Biological fixation.