Comparative Analysis of Functional Outcomes in Open vs. Minimally Invasive Fixation of Tibial Fractures
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/050Keywords:
Tibial Fractures, Surgery, Fracture Fixation, Minimally Invasive proceduresAbstract
Background: Tibial fracture is among the commonest long bone injury and is highly morbid. Even though open reduction and internal fixation (ORIF) was a traditional method, minimally invasive plate osteo-synthesis (MIPO) is becoming more popular as a procedure has fewer soft tissue disruptions and improved biological recovery. This study was intended to compare the functional outcome of ORIF and MIPO in repairing tibial fractures.
Methods: Random assignment was done to 120 tibial fracture patients in two groups of Group A (ORIF, n=60) and Group B (MIPO, n=60). Conditional demographic and clinical characteristics were observed. Functional recovery was measured using union time, the range of motion (ROM) and complication rates. The data were analyzed using independent t -tests and chi -square tests, and p = 0.05 was considered to be statistically significant.
Results: The characteristics such as age and gender distribution did not differ between groups at baseline (p > 0.05). MIPO patients had reduced mean union time (18.6 ±3.2 weeks vs. 21.4±3.7 weeks, p = 0.01) and higher knee and ankle ROM at the end of follow-ups (p = 0.03). There were 4 (6.7%) patients infected in the MIPO group versus 9 (15.0%) in the ORIF group, and delayed union was seen in 3 (5.0%) in the MIPO group versus 8 (13.3%) in the ORIF group both significantly lower. The MIPO-treated patients had higher functional outcome scores in a consistent manner.
Conclusion: MIPO is linked to better healing, better joint mobility and few complications in relation to ORIF in tibial fractures.
References
1. Erivan R, Caputo T, Monadjemi S, Pereira B, Descamps S, Boisgard S, et al. A comparison of minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in the management of tibial pilon fractures: A prospective randomized study. Orthop Traumatol Surg Res. 2025 Jun 19:104323. doi: 10.1016/j.otsr.2025.104323.
2. Shakya S, Wen Y, Wen X, Long C. Minimally invasive plate osteosynthesis (MIPO) with mini-open technique versus open reduction and internal fixation (ORIF) in the treatment of displaced midclavicular fracture: a retrospective study. J Orthop Traumatol. 2025 Aug 2;26(1):51. doi: 10.1186/s10195-025-00865-8.
3. Sourougeon Y, Barzilai Y, Haba Y, Spector B, Prat D. Outcomes following minimally invasive plate osteosynthesis (MIPO) application in tibial pilon fractures - A systematic review. Foot Ankle Surg. 2023 Dec;29(8):566-575. doi: 10.1016/j.fas.2023.07.013.
4. You JM, Wu YS, Wang Y. Comparison of post-operative numbness and patient satisfaction using minimally invasive plate osteosynthesis or open plating for acute displaced clavicular shaft fractures. Int J Surg. 2018 Aug;56:21-25. doi: 10.1016/j.ijsu.2018.06.007.
5. Wang C, Huang Q, Lu D, Wang Q, Ma T, Zhang K, et al. A clinical comparative study of intramedullary nailing and minimally invasive plate osteosynthesis for extra-articular distal tibia fractures. Am J Transl Res. 2023 Mar 15;15(3):1996-2005.
6. Bleeker NJ, van Veelen NM, van de Wall BJM, Sierevelt IN, Link BC, Babst R, et al. MIPO vs. intra-medullary nailing for extra-articular distal tibia fractures and the efficacy of intra-operative alignment control: a retrospective cohort of 135 patients. Eur J Trauma Emerg Surg. 2022 Oct;48(5):3683-3691. doi: 10.1007/s00068-021-01836-4.
7. Xu H, Chen P, Zhang Y, Huang H, Xie X, Ren Z. Intramedullary nailing versus minimally invasive plate osteosynthesis (MIPO) for proximal tibial fracture: a systematic review and meta-analysis. J Orthop Surg Res. 2025 Jul 16;20(1):663. doi: 10.1186/s13018-025-06094-3.
8. Zhou H, Zhang Y, Wei L, Ge X, Liu D, Dong Y, et al. Postoperative functions and complications in minimally invasive percutaneous plate osteosynthesis compared with intramedullary nail for distal tibial fractures: a meta-analysis and systematic review. Int J Surg. 2025 Aug 1;111(8):5582-5592. doi: 10.1097/JS9.0000000000002620.
9. Alsharef JF, Ghaddaf AA, AlQuhaibi MS, Shaheen EA, AboAljadiel LH, Alharbi AS, et al. External fixation versus intramedullary nailing for the management of open tibial fracture: meta-analysis of randomized controlled trials. Int Orthop. 2023 Dec;47(12):3077-3097. doi: 10.1007/s00264-023-05879-7.
10. Kaya O, Tosun HB, Kürüm H, Serbest S, Uludağ A, Ayas O. Comparative Study of Minimally Invasive Plate Osteosynthesis (MIPO) and Intramedullary Nailing (IMN) for Treating Extraarticular Distal Tibial Fractures: Clinical and Radiological Outcomes. Med Sci Monit. 2023 Oct 16;29:e942154. doi: 10.12659/MSM.942154.
11. Bhardwaj R, Agrawal U, Vashist P, Manna S. Determination of sample size for various study designs in medical research: A practical primer. J Family Med Prim Care. 2024 Jul;13(7):2555-2561. doi: 10.4103/jfmpc.jfmpc_1675_23.
12. Beytemür O, Barış A, Albay C, Yüksel S, Çağlar S, Alagöz E. Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2). Acta Orthop Traumatol Turc. 2017 Jan;51(1):12-16. doi: 10.1016/j.aott.2016.07.010.
13. Liu XK, Xu WN, Xue QY, Liang QW. Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta-Analysis. Orthop Surg. 2019 Dec;11(6):954-965. doi: 10.1111/os.12575.
14. Naude JJ, Manjra MA, Birkholtz F, Barnard AC, Tetsworth K, Glatt V, et al. Functional Outcomes and Quality of Life Following Complex Tibial Fractures Treated with Circular External Fixation: A Comparison between Proximal, Midshaft, and Distal Tibial Fractures. Strategies Trauma Limb Reconstr. 2021 Jan-Apr;16(1):32-40. doi: 10.5005/jp-journals-10080-150.
15. Giannoudis VP, Ewins E, Taylor DM, Foster P, Harwood P. Clinical and Functional Outcomes in Patients with Distal Tibial Fracture Treated by Circular External Fixation: A Retrospective Cohort Study. Strategies Trauma Limb Reconstr. 2021 May-Aug;16(2):86-95. doi: 10.5005/jp-journals-10080-1516.
16. Zhao Y, Wu J, Wei S, Xu F, Kong C, Zhi X, et al. Surgical approach strategies for open reduction internal fixation of closed complex tibial Pilon fractures based on axial CT scans. J Orthop Surg Res. 2020 Jul 27;15(1):283. doi: 10.1186/s13018-020-01770-y.
17. Malik-Tabassum K, Pillai K, Hussain Y, Bleibleh S, Babu S, Giannoudis PV, et al. Post-operative outcomes of open reduction and internal fixation versus circular external fixation in treatment of tibial plafond fractures: A systematic review and meta-analysis. Injury. 2020 Jul;51(7):1448-1456. doi: 10.1016/j.injury.2020.04.056.
18. Lo CH, Chen CH. Comparison of minimally invasive percutaneous fixation and open reduction internal fixation for patella fractures: a meta-analysis. J Orthop Surg Res. 2021 Aug 17;16(1):506. Doi: 10.1186/s13018-021-02612-1
19. Elnewishy A, Elkholy M, Hamada A, Salem M, Salem Jr M. Comparing minimally invasive percutaneous plate osteosynthesis with interlocking intramedullary nail fixation for the management of adult extra-articular distal tibial fractures: a comprehensive systematic review and meta-analysis. Cureus. 2023 Nov 21;15(11). e49214. doi: 10.7759/cureus.49214
20. Attia AK, Fayed A, Mahmoud K, Labib SA, Aydogan U, Juliano P. Locked intramedullary nailing provides superior functional outcomes and lower complication rates than plate fixation of distal fibula fractures. A systematic review and meta-analysis of comparative studies. Foot Ankle Surg. 2022 Oct 1;28(7):986-994. doi: 10.1016/j.fas.2022.02.005
21. Kang H, Rho JY, Song JK, Choi J, suk Kwon Y, Choi S. Comparison between intramedullary nailing and minimally invasive plate osteosynthesis for tibial shaft fractures. Injury. 2021 Apr 1;52(4):1011-1016. doi: 10.1016/j.injury.2021.01.038
22. Saxena A, Mahore SK, Gupta A, Sriwastava AK, Gupta M. Comparative Evaluation of Functional Outcomes Following Surgical and Conservative Management of Distal Tibia Shaft Fractures: A Prospective Observational Study. J Orthop Case Rep. 2025 Jul;15(7):275-281. doi: 10.13107/jocr.2025.v15.i07.5848.
23. Li X, Chen K, Xue H, Cheng J, Yu X. Efficacy comparison between intramedullary nail fixation and plate fixation in distal tibia fractures: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2024 Jul 12;19(1):403. doi: 10.1186/s13018-024-04900-y
24. Kariya A, Jain P, Patond K, Mundra A. Outcome and complications of distal tibia fractures treated with intramedullary nails versus minimally invasive plate osteosynthesis and the role of fibula fixation. Eur J Orthop Surg Traumatol. 2020 Dec;30(8):1487-1498. doi: 10.1007/s00590-020-02726-y
25. Bangura ML, Luo H, Zeng T, Wang M, Lin S, Chunli L. Comparative analysis of external locking plate and combined frame external fixator for open distal tibial fractures: a comprehensive assessment of clinical outcomes and financial implications. BMC Musculoskelet Disord. 2023 Dec 11;24(1):962. doi: 10.1186/s12891-023-07097-z
26. Biswas B, Halam AK, Chowdhury A, Purkayastha T, Reang S. Optimizing Surgical Management of Tibial Plateau Fractures: A Comparative Study of Minimally Invasive Versus Open Reduction Techniques. Cureus. 2024 May 11;16(5). e60078. doi: 10.7759/cureus.6007.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
Metrics
How to Cite
