Objective:

To compare the perioperative parameters, functional outcomes, radiographic results, and complications of suprapatellar intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) for distal tibial fractures, emphasizing their comparative effectiveness.

Key Findings:

• IMN group had shorter operative time, less blood loss, and smaller incisions (P < 0.001).
• MIPO group required fewer fluoroscopic exposures (P < 0.001).
• IMN showed superior functional outcomes at 1 and 3 months (P < 0.05), with no differences at 6 and 12 months.
• Time to union was shorter in the IMN group (21.8 ± 2.6 vs. 23.7 ± 2.9 weeks, P = 0.005).
• Anterior knee pain was more common after IMN, while incision-related complications were more frequent after MIPO.
• Alignment control was better with MIPO, indicating a trend toward improved outcomes.

Interpretation:

Both surgical techniques are effective, with IMN favoring early recovery and fracture healing, while MIPO offers better alignment control, suggesting individualized surgical strategies.

Limitations:

• Non-randomized selection of surgical technique based on clinical decision-making.
• Potential selection bias inherent to retrospective designs.
• Small sample size may limit generalizability of findings.

Conclusion:

Surgical strategy for distal tibial fractures should be individualized based on patient and fracture characteristics.