Background:Distal tibial fractures are the most common long bone fractures. An incidence of 17 per 100 000 person-years, although more recent data indicate that the incidence may be declining.The tibia is the second largest bone in the body. There are two concave condyles at the proximal aspect of the tibia. The medial condyle is larger, deeper, and narrower than the lateral condyle. An elevated process, the tibial tubercle, located between the two condyles is the site of attachment of the patellar tendon. The shaft of the tibia is prismoid, with a broad proximal extent that decreases in size until the distal third, where it gradually increases in size. The tibial crest is prominent medially from the tibial tubercle to the tibial plafond and is subcutaneous without any overlying muscles.The slightly expanded distal end of the tibia has anterior, medial, posterior, lateral and distal surfaces. The distal end of the tibia, when compared to the proximal end, is laterally rotated (tibial torsion). The torsion begins to develop in utero and progresses throughout childhood and adolescence till skeletal maturity is attained.minimal invasive plate fixation (MIPO) is recommended to limit this complication and given more stability. The basic principles of this technique include in direct closed reduction, extra periosteal dissection, anatomic alignment. Plate length and screw density are key factors for the stability of fixation.Comminuted fibular fractures fixed with MIPO technique using a long bridging plate, or intramedullary fixation of the fibula with a small diameter flexible nail