Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 1 2025 03 02 15 19 Reza Zandi Associate professor of Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shahin Talebi Assistant professor of Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Amir Mehrvar Associate professor of Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shirin Sheibani Medical Doctor, Student Research Committee, School of Medicine, Mazandaran University of Medical Science, Sari, Iran. Akbar Ehsani Orthopedic Surgeon, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Saeed Nodehi Resident of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 07 24 2025 02 24 Background: Despite the array of surgical and non-surgical approaches available for treating distal tibia fractures, managing unstable fractures continues to pose a challenge. This study compares the advantages and clinical outcomes of minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) in managing distal third tibia fractures. Methods: Our study focused on 60 cases selected based on age and fracture type. A comparative analysis was performed between two groups, examining factors such as age, gender, AO Foundation and Orthopedic Trauma Association (AO/OTA) fracture type, length of hospital stays, surgical duration, complication rates, time to return to daily routines, and adherence to the criteria set by the American Orthopedic Foot and Ankle Society (AOFAS). Results: The blood loss during surgery was significantly more in the ORIF group (142 ± 56.83 ml versus 81.83 ± 37.63 ml) (P < 0.05). The rate of complications was significantly higher in the ORIF group compared to the MIPO group (P < 0.05). Time for back to routines was significantly shorter in the MIPO group (17.63 ± 7.86 weeks versus 22.36 ± 8.81 weeks) (P < 0.05). No significant differences were found in surgery duration, hospitalization time,, time of hospitalization, and AOFAS score between the MIPO and ORIF groups. Conclusion: The optimal method for managing distal tibia fractures remains uncertain due to discrepancies between the outcomes of MIPO and ORIF. We favor MIPO due to its potential for early bone union, quicker return to normal activities, and reduced risk of wound complications. https://jost.tums.ac.ir/index.php/jost/article/view/610 https://jost.tums.ac.ir/index.php/jost/article/download/610/398