Minimally invasive percutaneous plate osteosynthesis (MIPPO) has become widely practiced in the operative management of articular, metaphyseal and transitional zone fractures. Early indirect reduction of such fractures of the distal tibia can be achieved easily using a simple quadrilateral frame. This enables CT scanning where required and allows the soft tissues to be assessed with ease. Distal tibial anatomical locking compression plates (LCP Synthes UK) have recently become available. Retrograde insertion of the AO distal tibial anatomical LCP via a distal transverse wound enables the MIPPO to be completed rapidly, with minimal surgical trauma to the zone of injury, with the frame in place until the procedure is completed-a particular advantage in these often highly unstable injuries.