Evaluation of distal tibial fractures with soft tissue injury treated using locking plate as an external fixator: a prospective study

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Background: Distal tibial fractures are frequently associated with significant soft tissue injury because of the subcutaneous location and limited vascularity of the distal tibia. Management of these fractures remains challenging, as conventional internal fixation may increase the risk of wound complications, infection, and delayed healing. The use of a locking plate as an external fixator, also known as supercutaneous plating, has emerged as a minimally invasive alternative that provides stable fixation while preserving soft tissue integrity. Objective was to evaluate the clinical, functional, and radiological outcomes of distal tibial fractures associated with soft tissue injury treated using a locking plate as an external fixator. Methods: This prospective hospital-based study included 32 patients with distal one-third tibial fractures associated with soft tissue injury treated between October 2022 and March 2024. Closed fractures with significant soft tissue compromise and open fractures up to Gustilo-Anderson type IIIA were included. Patients were followed up at regular intervals with clinical and radiological assessment. Outcome measures included time to fracture union, time to full weight bearing, complications, and functional outcomes assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS). Results: The mean age of the patients was 42.9±11.4 years. Road traffic accidents were the most common mechanism of injury. Eighteen patients had open fractures. The mean time to radiological union was 15.66±2.25 weeks. Full weight bearing was achieved at a mean of 14.22±2.52 weeks, and the mean time to plate removal was 19.25±2.45 weeks. Pin tract infection occurred in 6 patients and was superficial in all cases. The mean postoperative AOFAS score was 93±2.59, indicating excellent functional outcome. Conclusions: Locking plate used as an external fixator is a safe, effective, and minimally invasive technique for the management of distal tibial fractures associated with soft tissue injury, providing excellent functional and radiological outcomes with low complication rates.

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