Background: Distal tibial fractures are usually the result of high-energy axial compression and rotation forces. They are usually associated with severe soft tissue compromise. The limited soft tissue, subcutaneous location and poor vascularity make these fractures very challenging. Objectives: The aim of the current work was to evaluate clinically and radiologically the results of the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique in fixation of distal tibial fractures. Patients and methods: This prospective study included a total of 18 cases of type A distal tibial fractures treated by locked distal tibial plate, attending at ZAGAZIG University Hospitals. The fractures were classified using the method of AO classification. This study was conducted between February 2018 and April 2019. Results: A comprehensive sample will be taken including cases that need minimally invasive percutaneous plate osteosynthesis in treatment of distal tibial fractures, 3 cases / month, sample equal 18 / 6 months who have traumatic fracture distal tibia on Orthopedic Surgery Department, Zagazig University Hospitals. Conclusion: MIPO is simple, safe and effective method of treatment for diaphyseal & metaphyseal fractures. It does not require direct visualization of the fracture at the cost of extensive soft tissue dissection. We are confident in suggesting this alternative approach of plating. MIPPO through the deltoid-pectoralis approach seems superior to conventional ORIF through the deltoid-pectoralis approach in the treatment of PHF in elderly patients in terms of Constant-Murley score, NEER score, intraoperative blood loss, length of operation and SF36 score.