Distal tibial fractures constitute a wide spectrum of lesions from simple metaphyseal and diaphyseal fractures to methaphyseal collapse with articular surface impaction and severe compromise of the soft tissue. The standard of care still remains controversial. This review discusses the indications for minimally-invasive techniques based on fracture pathoanatomy. A surgical approach is proposed, reserving arthoscopically-assisted reduction of the joint surface for particular cases. A literature review is conducted, describing surgical outcomes and complications.