Distal femur fractures account for approximately 4–6% of all femoral fractures and 0.4% of all fractures in adults, with a reported incidence of 37 cases per 100,000 persons annually in developed countries [1,2]. These injuries typically present a bimodal age distribution: high-energy trauma such as road traffic accidents in younger individuals and low-energy falls in the elderly with osteoporotic bone [3]. In India, with increasing road traffic density and an ageing population, the burden of distal femur fractures is rising, posing significant challenges to orthopaedic surgeons [4].

The management goal is to achieve anatomical alignment, stable fixation, and early mobilization to restore knee function and prevent complications such as joint stiffness, malunion, or non-union [5]. However, the complex anatomy of the distal femur, thin cortices, metaphyseal flare, and proximity to the knee joint make these fractures technically demanding to treat [6].

Open reduction and internal fixation (ORIF) with locking compression plates has been the conventional gold standard, allowing direct visualization of the fracture, accurate reduction, and rigid fixation [7]. Nevertheless, the extensive soft tissue dissection and periosteal stripping associated with ORIF can compromise fracture biology, delay healing, and increase the risk of infection [8].

Minimally invasive plate osteosynthesis (MIPO), introduced in the early 1990s, is designed to preserve the fracture’s biological environment by limiting soft tissue damage and maintaining periosteal blood supply [9]. This technique involves indirect reduction under fluoroscopic guidance and submuscular tunneling of the plate, leading to faster healing and potentially better functional outcomes [10,11].

Multiple studies have reported favorable results with MIPO in terms of union rates, functional recovery, and complication profile compared to ORIF [12,13]. However, other reports have noted that in complex intra-articular fractures, particularly AO/OTA type 33C, achieving precise articular congruity via MIPO can be challenging and may require a combination approach [14].

Given the variability in outcomes reported across different populations and the limited prospective comparative studies from North India, this study was undertaken to compare the functional and radiological outcomes of ORIF versus MIPO in distal femur fractures treated at a tertiary care teaching hospital. The aim was to generate region-specific evidence to guide surgical decision-making in our patient population.