{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:54:52Z","timestamp":1781650492793,"version":"3.54.5"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study included 70 patients with distal one-third tibial fractures treated with suprapatellar IMN (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935) or MIPO (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935) between January 2021 and December 2024. Perioperative data, functional outcomes (VAS, AOFAS, Lysholm, and ROM), radiographic results, and complications were assessed during a 12\u201318 month follow-up. Multivariate logistic regression identified independent risk factors for complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The IMN group had shorter operative time, less blood loss, and smaller incisions (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), whereas the MIPO group required fewer fluoroscopic exposures (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). At 1 and 3 months, IMN showed superior VAS, AOFAS, Lysholm scores, and knee ROM (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05), with no differences at 6 and 12 months. Time to union was shorter in the IMN group (21.8\u2009\u00b1\u20092.6 vs. 23.7\u2009\u00b1\u20092.9 weeks,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both techniques are effective. IMN favors early recovery and fracture healing, whereas MIPO offers better alignment control. Surgical strategy should be individualized.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1869900","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:10:43Z","timestamp":1781647843000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative clinical outcomes of suprapatellar intramedullary nailing vs. minimally invasive plate osteosynthesis fixation for distal tibial fractures: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Bing","family":"Song","sequence":"first","affiliation":[{"name":"Department of Orthopedic, Qilu Hospital Dezhou Hospital, Shandong University","place":["Dezhou, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuxue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Interventional Medicine, Qilu Hospital Dezhou Hospital, Shandong University","place":["Dezhou, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jize","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Qilu Hospital Dezhou Hospital, Shandong University","place":["Dezhou, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: a review","volume":"37","author":"Court-Brown","year":"2006","journal-title":"Injury"},{"key":"B2","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1016\/j.injury.2014.12.027","article-title":"Incidence and epidemiology of tibial shaft fractures","volume":"46","author":"Larsen","year":"2015","journal-title":"Injury"},{"key":"B3","doi-asserted-by":"publisher","first-page":"406","DOI":"10.5435\/00124635-200607000-00003","article-title":"Surgical treatment of nonarticular distal tibia fractures","volume":"14","author":"Bedi","year":"2006","journal-title":"J Am Acad Orthop Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s00264-009-0832-z","article-title":"Distal tibia fractures: management and complications of 101 cases","volume":"34","author":"Joveniaux","year":"2010","journal-title":"Int Orthop"},{"key":"B5","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1016\/j.injury.2010.02.019","article-title":"Distal metadiaphyseal tibial fractures","volume":"42","author":"Newman","year":"2011","journal-title":"Injury"},{"key":"B6","doi-asserted-by":"publisher","first-page":"S11","DOI":"10.1016\/S0020-1383(07)80004-0","article-title":"Risk factors contributing to fracture non-unions","volume":"38","author":"Calori","year":"2007","journal-title":"Injury"},{"key":"B7","first-page":"868","volume-title":"AO principles of Fracture Management","author":"Ruedi","year":"2000"},{"key":"B8","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.ocl.2009.07.009","article-title":"Soft tissue and biomechanical challenges encountered with the management of distal tibia nonunions","volume":"41","author":"Tarkin","year":"2010","journal-title":"Orthop Clin North Am"},{"key":"B9","doi-asserted-by":"publisher","first-page":"3683","DOI":"10.1007\/s00068-021-01836-4","article-title":"MIPO Vs. 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