Minimally Invasive Plate Osteosynthesis (MIPO) Versus Conventional Open Reduction and Internal Fixation (ORIF) in The Management of Distal Tibial Fractures

Abstract

Distal tibial fractures pose special problems in terms of surgical treatment because of precarious blood supply and thin, soft tissue envelopes. Where resources are limited as in the case of Iraq, the most important aspect is to reduce complications by maximizing outcomes. This was a prospective cohort study that compared the use of minimally invasive plate osteosynthesis (MIPO) to the conventional open reduction and internal fixation (ORIF) in sixty-four patients who had AO/OTA 43-A and 43-B fracture of the distal tibia at the Al-Karama Teaching Hospital between January and December 2023. The patients were divided into MIPO (n = 32) and ORIF (n = 32), according to the surgical schedule and feasibility of the operations. The Olerud-Molander Ankle Score (OMAS) at 12 months, time to radiological union, and complication rates were considered as primary outcome measures. The secondary outcomes included hardware-related issues and return-to-work interval. The MIPO group recorded a much better mean OMAS score (78.4 ± 9.2 vs. 67.1 ± 11.5; p = 0.002), union time (14.2 ± 2.1 vs. 17.8 ± 3.4 weeks; p < 0.001), and superficial infection rates (6.3% vs. 25.0%; p = 0.048). The deep infection incidence and malunion rates were found not to differ significantly (p = 0.32 and p = 0.31) respectively. These results indicate that MIPO represents better functional recovery and lower early morbidity in the Iraqi clinical setting, despite constraints in postoperative rehabilitation and follow-up adherence. An algorithm of surgical decisions is suggested to be adapted locally and provide guidance for implementation in similar settings.