Provisional Reduction Plating Versus External Fixation in the Staged Management of Gustilo–Anderson Type II–III Open Tibial Shaft Fractures

Background/Objectives: Open tibial shaft fractures are severe injuries associated with high risks of infection and malunion. Although external fixation is commonly used for provisional stabilization, it provides limited control over alignment and soft tissue handling. This study aimed to evaluate and compare provisional reduction plating with external fixation for the staged management of Gustilo–Anderson type II–III open tibial fractures. Methods: Fifty-nine patients (mean age, 38.5 years) treated with staged debridement and delayed intramedullary nailing (IMN) were retrospectively reviewed. Thirty-two patients underwent reduction plating with external fixation (group A), and 27 underwent external fixation alone (group B). Clinical, radiographic, and functional outcomes, including infection, union, malunion, operative time, and Lower Extremity Functional Scale (LEFS) scores, were analyzed. Results: Deep infection and nonunion rates were comparable between the groups. Group A had fewer malunions (3.1% vs. 18.5%), shorter operative times, and faster progression to union than group B. The LEFS scores were higher in group A, indicating better functional recovery. Conclusions: Provisional reduction plating before IMN appears to enhance alignment, preserve soft tissue integrity, and improve surgical efficiency without increasing the risk of infection or delaying union. These findings suggest that it may be a safe and effective adjunct to the staged treatment of complex Gustilo–Anderson type II–III open tibial fractures.