Distal tibial fractures which are complex injuries extending from distal metaphysis to the tibial articular surface usually present with open fractures. Treatment of distal tibial fractures, which is commonly accompanied by soft tissue injuries is challenging than the treatment of other types of fractures. Currently, development of minimally invasive surgical techniques and increased popularity of biological osteosynthesis with locking plates have led to increased treatment options. Higher success rate of minimally invasive plate osteosynthesis in the treatment of distal tibial fractures were reported in the literature. The introduction of fixed-angle locking plating has resulted in reduced surgical trauma in the injury site, protection of the circulation around the tissues in the fracture zone and better fixation, particularly in osteoporotic bone fractures. In addition, increased resistance to bending and shearing forces on defective and comminuted metaphyseal fractures has led to reduction in the risk of angular deformities. With respect to its merits, minimally invasive surgery with locking plates is an effective treatment of choice for distal tibial fractures. However, it must be kept in mind that the procedure has several disadvantages, including high cost, close reduction technique, technical complications, the need for fluoroscopy, intraoperative high-dose radiation exposure.