Surgical treatment of distal tibial fractures is challenging because of the limited soft tissue coverage and poor vascularity. Managing these orthopedic conditions in pregnant patient is a great challenge for the safety of both mother and fetus. Intra-operative fluoroscopy can be used just when appropriate. Minimally Invasive Plate Osteosynthesis (MIPO) technique is a method of fixation that reduces surgical trauma without exposure of fractured zone. By using an identical plate to the first one already placed percutaneously, plate on plate technique reduces radiation exposure, operating time, amount of surgical trauma and cost of treatment. The holes of the second plate are used to guide the mini skin incisions for accurate placement of screws. Here we present a case of distal tibial fracture at the first gestation trimester treated with MIPO using a plate on plate technique.