Comparative clinical outcomes of suprapatellar intramedullary nailing vs. minimally invasive plate osteosynthesis fixation for distal tibial fractures: a retrospective cohort study.

INTRODUCTION: Distal tibial fractures are challenging injuries due to limited soft tissue coverage and complex biomechanics. Suprapatellar intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) are widely used; however, their comparative effectiveness remains controversial. This study compared perioperative parameters, functional outcomes, radiographic results, and complications to inform surgical decision-making.

METHODS: This retrospective cohort study included 70 patients with distal one-third tibial fractures treated with suprapatellar IMN (n = 35) or MIPO (n = 35) between January 2021 and December 2024. Perioperative data, functional outcomes (VAS, AOFAS, Lysholm, and ROM), radiographic results, and complications were assessed during a 12-18 month follow-up. Multivariate logistic regression identified independent risk factors for complications.

RESULTS: The IMN group had shorter operative time, less blood loss, and smaller incisions (all P < 0.001), whereas the MIPO group required fewer fluoroscopic exposures (P < 0.001). At 1 and 3 months, IMN showed superior VAS, AOFAS, Lysholm scores, and knee ROM (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). Alignment was comparable, although MIPO showed a trend toward better control. Anterior knee pain was more common after IMN, while incision-related complications were more frequent after MIPO. Fracture classification, surgical method, operative time, and BMI were independent risk factors.

CONCLUSION: Both techniques are effective. IMN favors early recovery and fracture healing, whereas MIPO offers better alignment control. Surgical strategy should be individualized.