Plate Fixation of Open Fractures of the Tibia

Author summary

The outcomes of 97 open tibial fractures in 95 patients treated with immediate plate fixation are reported, focusing on wound healing, time to full weight-bearing (union), function, and complications, including malunion and infection. Overall, 62 wounds healed in 3 weeks or less and 26 between 3 and 6 weeks. By 30 weeks, 77 legs were fully weight-bearing and significant stiffness in one or more of the knee, ankle, or subtalar joints developed in 11.4 % patients. Delayed union occurred in 32 cases (33 %). Angular malunion of greater than 5° in any plane was seen in only 3.1 % of patients. The deep infection rate was 10.3 % overall, including 5.4 % of Grade I wounds, 7.8 % of Grade II wounds, and 44.4 % of Grade III wounds. These rates compared well against outcomes from various other studies, indicating that plate fixation of Grade I and Grade II open fractures is a viable treatment option. However, in Grade III open fractures, due to the higher incidence of infection, plating is probably best avoided.

Background

This study explored the effectiveness of treating open fractures of the tibia with internal fixation using plates, a method considered controversial at the time due to concern for an increased risk of infection. External fixation and more conservative methods, such as cast immobilization, were considered the treatment of choice. However, there was some evidence at the time suggesting that the stability provided by internal fixation might actually lead to early soft tissue healing and the avoidance of infection.