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.