Low Profile, High Impact: External Fixation using Locking Plates in Challenging Tibial Fractures

Introduction: Treating metadiaphyseal tibial fractures with compromised soft tissues remains a surgical challenge. While traditional external fixators are widely used, locking compression plates (LCPs) applied externally as fixators offer a promising alternative due to their low-profile design and angular stability. Objectives: The objective is to evaluate clinical outcomes, union rates, complications, and functional recovery in patients treated with locking plate external fixators (LPEFs) for metadiaphyseal tibia fractures. Materials and Methods: This prospective study of 15 adult patients with open or soft-tissue-compromised metadiaphyseal tibia fractures was conducted over 12 months. All patients were managed using LCP as an external fixator. Radiological union, time to weight-bearing, infection rates, reoperation need, and functional outcomes (knee society score [KSS] and the American Orthopaedic Foot and Ankle Society [AOFAS]) were assessed. Results: The mean time to union was 12.1 weeks, with a union rate of 90%. One superficial infection (6.6%) and one reoperation (6.6%) were noted. The final follow-up revealed excellent functional outcomes: Mean KSS score of 85 ± 5 and AOFAS of 81 ± 4. Conclusion: LPEF offers a viable fixation method in managing complex tibial fractures with soft-tissue compromise, allowing early mobilization, fewer complications, and excellent functional outcomes. Larger studies are needed to validate its widespread adoption.