Clinical and functional outcomes of minimally invasive anterolateral plating for distal tibial fractures: a retrospective cohort study

This study evaluated the clinical and functional outcomes of minimally invasive anterolateral locked plating for distal tibial fractures. In this retrospective cohort study, 72 patients with distal tibial fractures (AO/OTA types 43-A, B, and C) were treated between March 2022 and March 2025 using a minimally invasive anterolateral approach with a locked distal tibial plate. Exclusion criteria included open fractures, AO/OTA types 43-B3/C3, polytrauma, and pre-existing limb deformities. Postoperative clinical and radiological outcomes were assessed, and functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Functional outcome and complications were recorded over a mean follow-up of 24 months. The mean age was 45.9 ± 16.6 years; 67% were male, 27% had diabetes, and 22% were smokers. The most common cause of injury was motor vehicle collisions (MVC). Patients included AO 43-A (66.7%), 43-B (22.2%), and 43-C (11.1%) fractures. Most patients maintained an average postoperative range of motion with acceptable alignment. According to AOFAS scores, 72% achieved excellent results, 22% good results (approximately 95% overall satisfaction), and 5% unsatisfactory results. Complications included delayed union (5.6%, predominantly diabetics/smokers), superficial peroneal nerve (SPN) paresthesia (1.4%), and superficial infection (5.6%). Two patients (2.9%) required elective hardware removal. Minimally invasive anterolateral plating for distal tibial fractures provides reliable fracture stabilization with a high rate of union, acceptable alignment and good functional outcomes making it a favorable treatment option. The approach-specific risk of superficial peroneal nerve neuropraxia, while inherent to anterolateral plating, can be effectively mitigated through meticulous surgical technique, careful identification and protection during exposure.