Radiological Union, Complications, and Functional Recovery after Tibial MIPPO with Fibular Intramedullary Nailing for Distal Both Bone Leg Fractures: A Prospective Cohort Study

ABSTRACT Background: Distal tibia–fibula fractures are difficult to manage due to the restricted soft-tissue envelope and the need to maintain alignment while preserving fracture biology. This study assessed results of tibial MIPPO (minimally invasive plate osteosynthesis) with fibular IM (intramedullary) fixation. Methods: A prospective cohort of 30 adults with closed distal-third tibial fractures with concurrent fibular fractures treated with tibial MIPPO and fibular intramedullary nailing. Patients were followed for 24 weeks. The outcomes measured included radiological union, complications, RUST progression, AOFAS ankle–hindfoot scores, pain, ankle motion, and return to activity. Results: Tibial radiological union was achieved in 28 patients (93.3%) by 24 weeks, with a mean union time of 18.6±2.8 weeks; mean fibular union time was 14.3±3.2 weeks. Two patients had delayed union and none developed established nonunion. Superficial infection occurred in 13.3%, and 6.7% required unplanned reoperation. Mean AOFAS score improved from 47.3 at 6 weeks to 84.3 at 24 weeks (p<0.001). Greater comminution and high-energy injury were associated with longer union time. Conclusion: Combined tibial MIPPO and fibular intramedullary fixation produced high early union rates with progressive functional recovery and few major complications. Keywords: Distal tibia fracture; MIPPO; Fibular intramedullary nail; Fracture union; Functional outcome