Introduction: The anatomy around the ankle in– particular provides minimal soft tissue coverage for most orthopaedic implants as well as regions of poor vascularity that can be disrupted by trauma as well as surgical techniques. Surgical site infection is one of the most common complications following ankle fracture surgery

Objectives: The purpose of this study was to describe in detail the minimally invasive approach for distal fibula fractures that allows for anatomic reduction, minimal soft tissue disruption and providing the surgeon with the means of converting to the more conventional open procedure if required.

Materials and Methods: The study was prospective type of 18 patients (14 males, 4 females) with age group 18–75 years having isolated (8)/ pott’s(10) fibula fracture were fixed with 3.5 mm anatomical plating by MIPO approach. Patients were followed at 6 weeks,8 weeks, 12 weeks, 6 months and 1 year & functional assessment of the patient was done according to the AOFAS Ankle–Hindfoot Scale.

Results: At the final follow up, 13 patients had 85% AOFAS Ankle–Hindfoot Scale, 4 patients had 70% while 1 patient had <50% AOFAS Ankle–Hindfoot Scale. 13 (72%) patients had less than 30% postoperative restriction of ankle joint movement, 4 patients(22%) had 30–60%  restriction of ankle joint movement while 1(6%) patient had a severe restriction (>60%) of ankle joint movement. Average valgus angulation was 5.95. The complication was superficial infection seen in 1 patients and 1 patient had ankle stiffness. No deep infection/ non–union observed.

Conclusions: The MIPO technique is established for managing fractures of the distal fibula that has a reliable fixation approach while preserving the osseous vascularity and hematoma, thus facilitating better biological repair giving good result and early rehabilitation. This may in future become the preferred method of fixation by most surgeons. Considering the good outcome in this study, We recommend use of the MIPO technique for treatment of distal fibular fractures.