Abstract:

Purpose :  Open fractures are one of the most difficult condition to treat in orthopaedics. Locking plates can be used as an external fixator in case of open  fracture particularly of tibia  as soft tissue around it (especially distal ) are easily compromised by trauma and subsequent  treatment by open reduction and internal fixation. The purpose of our study is to evaluate the functional outcome of locking compression plate used as an external fixator in Gustilo  and Anderson’s grade II to III B  open  fracture shaft of tibia. Method :  This was a prospective study in which we treated a total of 8  patients  of Open fracture shaft of tibia with “supracutaneous plating” using a metaphyseal locking  plate or simple locking plates. There were 5 Male and 3 female patients, with average age of 40 years (Range, 28 to 60 years). 3 patient was having grade II injury,2patients were of grade IIIAwherea as 3 patients were having Grade IIIB injury.   After 4 weeks, patients were  allowed toe- touch weight bearing for next 6 weeks, followed by partial weight bearing for next 4 weeks. Full weight bearing was allowed once fracture healed clinically as well as radiologically. Plate removal was done once fracture consolidated radiologically. Result:  The  plate was kept in place for average 32 weeks (Range,28 to 40 weeks) .No significant screw tract infection was found in any patients in our series. In 1 patients flap coverage of wound was done, in others, wound healed with debridement, dressing and partial thickness skin grafting when required. (2). Two patients showed delayed union at 24 weeks for which bone grafting was done and fracture union was achieved.  Average period of follow-up was 16 months (Range, 12 to 20 months). In 7 patients, plate was placed in situ until full consolidation both clinically and radiologically was seen but in one patient plate has to be removed in 2 weeks because of loosening due highly osteoporotic bone and persistence of infection. She was planned for ring fixator but patient refused and we lost the follow up. At latest follow up all the7 patients were full weight bearing with fully healed tibia.Conclusion : Locked Supracutaneous plating of open fracture of long bones have many advantages over conventional tubular uniaxial fixator. Non bulky implant, stable configuration, less risk of pin tract infection, suitability of application even with small fragments and less chances of joint stiffness makes this method a viable option for treatment of open long bone fractures especially tibia. Keywords: Open fracture, Supracutaneous plating, External fixator, Locking plate.

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