Comparative Study of Functional and Radiological Outcome of Suprapatellar Tibial Nailing vs Minimally Invasive Plate Osteosynthesis in Proximal Fractures of Tibia

Abstract Background: Tibial fractures, particularly extra-articular proximal tibial fractures, present significant challenges due to their subcutaneous location, compromised soft-tissue envelope, and a high risk of malalignment. Both minimally invasive percutaneous plate osteosynthesis (MIPPO) and suprapatellar tibial nailing (SPTN) are widely used fixation techniques in proximal tibial fractures, each offering distinct biomechanical and biological advantages. However, consensus regarding the superiority of one technique over the other remains inconclusive.Objectives: To compare the radiological and functional outcomes of proximal tibial fractures treated with MIPPO and suprapatellar tibial nailing.Materials and Methods: This prospective comparative study included 40 patients with extra-articular proximal tibial fractures, divided into two groups: Group 1: MIPPO (n = 20) Group 2: Suprapatellar tibial nailing (n = 20) Patients were evaluated for peri-operative parameters including duration of surgery, intra-operative blood loss, and hospital stay. Clinical and radiological assessments included time to weight bearing, radiological union, coronal and sagittal alignment, and functional outcome using the Knee Society Score (KSS) at 1, 3, and 6 months. Postoperative complications were also recorded. Statistical analysis was performed using the unpaired t-test and Chi-square test, with P < 0.05 considered statistically significant xResults: There was no statistically significant difference between the two groups in terms of hospital stay, duration of surgery, intra-operative blood loss, time to radiological union, or final alignment. Early weight bearing was more frequently achieved in the suprapatellar tibial nailing group, whereas delayed weight bearing was more common in the MIPPO group, showing a borderline trend. Functional outcomes improved progressively in both groups, with the majority of patients achieving good to excellent KSS scores by 6 months. Overall complication rates were comparable between the two groups.Conclusion: Both MIPPO and suprapatellar tibial nailing are effective and reliable fixation methods for the management of extra-articular proximal tibial fractures, with comparable radiological and functional outcomes. Suprapatellar tibial nailing offers the advantage of earlier mobilization and improved control of proximal fragment alignment, while MIPPO provides satisfactory alignment with minimal soft-tissue disruption. The choice of fixation should be individualized based on fracture pattern, soft-tissue condition, and surgeon expertise.