• Ji Wan Kim, Hyun Uk Kim, Chang-Wug Oh, Joon-Woo Kim, and Ki Chul Park.
• *Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea;†Department of Orthopedic Surgery, Hanyang University Guri Hospital, Hanyang University, Guri, Republic of Korea; and‡Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University, Dae-gu, Republic of Korea.
• J Orthop Trauma. 2018 Jan 1; 32 (1): e19-e24.

ObjectivesTo compare the radiologic and clinical results of minimally invasive plate osteosynthesis (MIPO) and minimal open reduction and internal fixation (ORIF) for simple distal tibial fractures.DesignRandomized prospective study.SettingThree level 1 trauma centers.PatientsFifty-eight patients with simple and distal tibial fractures were randomized into a MIPO group (treatment with MIPO; n = 29) or a minimal group (treatment with minimal ORIF; n = 29). These numbers were designed to define the rate of soft tissue complication; therefore, validation of superiority in union time or determination of differences in rates of delayed union was limited in this study.InterventionSimple distal tibial fractures treated with MIPO or minimal ORIF.Main Outcome MeasurementsThe clinical outcome measurements included operative time, radiation exposure time, and soft tissue complications. To evaluate a patient's function, the American Orthopedic Foot and Ankle Society ankle score (AOFAS) was used. Radiologic measurements included fracture alignment, delayed union, and union time.ResultsAll patients acquired bone union without any secondary intervention. The mean union time was 17.4 weeks and 16.3 weeks in the MIPO and minimal groups, respectively. There was 1 case of delayed union and 1 case of superficial infection in each group. The radiation exposure time was shorter in the minimal group than in the MIPO group. Coronal angulation showed a difference between both groups. The American Orthopedic Foot and Ankle Society ankle scores were 86.0 and 86.7 in the MIPO and minimal groups, respectively. Minimal ORIF resulted in similar outcomes, with no increased rate of soft tissue problems compared to MIPO.ConclusionsBoth MIPO and minimal ORIF have high union rates and good functional outcomes for simple distal tibial fractures. Minimal ORIF did not result in increased rates of infection and wound dehiscence.Level Of EvidenceTherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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