Extra-articular Distal Tibial Fracture: A Comparative Study of the Outcome Between Closed IMLN and MIPO


  • Yad Atuf Abdulrahim Department of Orthopedic Surgery, Shar Teaching Hospital, Sulaimani, Kurdistan Region, Iraq. Author
  • Ali Abdalnabi Alwan Al-Tamimi Department of Orthopedic Surgery, Shar Teaching Hospital, Sulaimani, Kurdistan Region, Iraq. & Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. Author




Tibial fracture, Prospective study, Advanced technique, FAAM, Sulaimani city


Background: The treatment of distal tibial fractures (DTF) is still up for debate. For DTF, minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMLN) are potentially effective techniques; however, they have been linked to complications. Thus, this study was aimed to evaluate and compare clinical and functional results in individuals with DTF that were managed with MIPO or IMLN.

Patients and Methods: Between August 2020 and February 2022, 31 patients with closed extra-articular distal tibia fractures were enrolled in a comparative study of locking plate by MIPO versus closed IMLN at the Sulaimani Teaching Hospital and Shar Teaching Hospital. The Foot and Ankle Ability Measure (FAAM) and Johner and Wruh's criteria were used to evaluate the results.

Results: IMLN was used on 16 individuals, while MIPO was used on 15 patients that underwent surgery. In terms of time, there was no significant difference (p>0.05) in fracture union, malunion, or functional results. However, there was a significant difference in total weight-bearing following surgery, blood loss, and complications in terms of the operation time.

Conclusions: Both techniques were effective in treating a distal tibial extra-articular fracture. IMLN had a faster complete weight-bearing time and a shorter operation time. At the same time, MIPO had less blood loss and equal time in complete union. Thus, we recommend using FAAM as a valuable tool in evaluating functional outcomes after distal tibia fracture.


Liu X.K., Xu W.N., Xue Q.Y., & Liang Q.W. (2019). Intramedullary nailing versus minimally invasive plate osteosynthesis for distal tibial fractures: a systematic review and meta‐analysis. Orthopaedic Surgery. 11(6), 954-965. DOI: https://doi.org/10.1111/os.12575

Larsen P., Elsoe R., Hansen S.H., Graven-Nielsen T., Laessoe U., & Rasmussen S. (2015). Incidence and Epidemiology of Tibial Shaft Fractures. Injury. 46(4), 746-750. DOI: https://doi.org/10.1016/j.injury.2014.12.027

Kawalkar A.C. & Badole C.M. (2018). Distal tibia metaphyseal fractures: Which is better, intra-medullary nailing or minimally invasive plate osteosynthesis? Journal of Orthopaedics, Trauma and Rehabilitation. 24, 66-71. DOI: https://doi.org/10.1016/j.jotr.2017.09.004

Kulkarni V.S., Kulkarni M.S., Kulkarni G.S., Goyal V., & Kulkarni M.G. (2017). Comparison between antegrade intramedullary nailing (IMN), open reduction plate osteosynthesis (ORPO) and minimally invasive plate osteosynthesis (MIPO) in treatment of humerus diaphyseal fractures. Injury. 48, S8-S13. DOI: https://doi.org/10.1016/S0020-1383(17)30487-4

Barcak E. & Collinge C.A. (2016). Metaphyseal distal tibia fractures: a cohort, single-surgeon study comparing outcomes of patients treated with minimally invasive plating versus intramedullary nailing. Journal of Orthopaedic Trauma. 30(5), e169-e174. DOI: https://doi.org/10.1097/BOT.0000000000000530

Sreejith T.J., Nagakumar J., Manohar P., & Karthik R.P. (2018). Minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal tibia fractures-retrospective functional and radiological outcome analysis among rural population. International Journal of Orthopaedics Sciences. 4(2), 596-600. DOI: https://doi.org/10.22271/ortho.2018.v4.i2i.89

Iqbal H. & Pidikiti P. (2013). Treatment of distal tibia metaphyseal fractures; plating versus intramedullary nailing: a systematic review of recent evidence. Foot and Ankle Surgery. 19(3), 143-147. DOI: https://doi.org/10.1016/j.fas.2013.04.007

Ali N., Bhat A., Bangroo F.A., Muzzafar K., Bhat S.A., Dhanda M.S., et al. (2017). Treatment of extra-articular distal tibial fractures: Minimally invasive percutaneous plate osteosynthesis versus intramedullary nailing. Trauma Monthly. 22(4), e19593. DOI: https://doi.org/10.5812/traumamon.19593

Borloz S., Crevoisier X., Deriaz O., Ballabeni P., Martin R.L., & Luthi F. (2011). Evidence for validity and reliability of a French version of the FAAM. BMC Musculoskeletal Disorders. 12(1), 1-6. DOI: https://doi.org/10.1186/1471-2474-12-40

Batta V, Dwyer AJ, Gulati A, Prakash J, Mam MK, John B. (2011). No difference in the long term final functional outcome after nailing or cast bracing of high energy displaced tibial shaft fractures. Journal of Trauma Management & Outcomes. 6(1), 1-6. DOI: https://doi.org/10.1186/1752-2897-6-5

Gonzalez-Sanchez M, Li GZ, Ruiz Munoz M, Cuesta-Vargas AI. (2017). Foot and ankle ability measure to measure functional limitations in patients with foot and ankle disorders: a Chinese cross-cultural adaptation and validation. Disability and Rehabilitation. 39(21), 2182-2189. DOI: https://doi.org/10.1080/09638288.2016.1219772

Wani IH, Ul Gani N, Yaseen M, Bashir A, Bhat MS, Farooq M. (2017). Operative management of distal tibial extra-articular fractures-intramedullary nail versus minimally invasive percutaneous plate osteosynthesis. Ortopedics, Traumatology and Rehabilties. 19(6), 537-541. DOI: https://doi.org/10.5604/01.3001.0010.8045

Gonsalves J. (2018). A comparative study of locking plate by MIPO versus closed interlocking intramedullary nail in extra-articular distal tibia fractures. International Journal of Orthopaedics Sciences. 3, 145-149. DOI: https://doi.org/10.22271/ortho.2018.v4.i3c.26

Li Y, Liu L, Tang X, Pei F., Wang G., Fang Y., et al. (2012). Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures. International Orthopaedics. 36(7), 1457-1462. DOI: https://doi.org/10.1007/s00264-012-1494-9

Guo J., Tang N., Yang H., & Tang T. (2010). A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. The Journal of Bone and Joint Surgery. British Volume. 92(7), 984-988. DOI: https://doi.org/10.1302/0301-620X.92B7.22959

Borrelli J.J., Prickett W., Song E., Becker D., & Ricci W. (2002). Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. Journal of Orthopaedic Trauma.16(10), 691-695. DOI: https://doi.org/10.1097/00005131-200211000-00002

Yang S.W., Tzeng H.M., Chou Y.J., Teng H.P., Liu H.H., & Wong C.Y. (2006). Treatment of distal tibial metaphyseal fractures: plating versus shortened intramedullary nailing. Injury. 37(6), 531-535. DOI: https://doi.org/10.1016/j.injury.2005.09.013

Janssen K.W., Biert J., & van Kampen A. (2007). Treatment of distal tibial fractures: plate versus nail. International Orthopaedics. 31(5):709-714. DOI: https://doi.org/10.1007/s00264-006-0237-1

Polat A., Kose O., Canbora K., Yanık S., & Guler F. (2015). Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial. Journal of Orthopaedic Science. 20(4), 695-701. DOI: https://doi.org/10.1007/s00776-015-0713-9

Kwok C.S., Crossman P.T., & Loizou C.L. (2015). Plate versus nail for distal tibial fractures: a systematic review and meta-analysis. Journal of Orthopaedic Trauma. 28(9), 542-548. DOI: https://doi.org/10.1097/BOT.0000000000000068



How to Cite

Extra-articular Distal Tibial Fracture: A Comparative Study of the Outcome Between Closed IMLN and MIPO. (2022). Journal of Zankoy Sulaimani - Part A, 24(2), 43-52. https://doi.org/10.17656/jzs.10880