Background: Distal tibia fractures are common injuries classically included between four and twelve cm from tibial plafond, even without articular extension they are considered to be inherently unstable. Surgical treatment of these fractures still challenging with a lot of complications including malunion, nonunion, and wound problems because of its subcutaneous location, precious vascularity and lack of muscle coverage. Although open reduction internal fixation with plates provides anatomical reduction and early mobilization, it cannot be considered as the first line of treatment for distal tibia fractures because of extensive soft tissue damage and high rate of infection. Intramedullary nailing is another choice which minimizes surgical insult to the fracture and allows early rehabilitation; however rates of nonunion and postoperative knee pain cannot be underestimated. Recently, MIPPO has been introduced as a good option for fixation of distal tibia fractures as it preserves periosteum and fracture hematoma, but it is not free of some disadvantages like angular deformity and hardware irritation.