Locking Plate Fixators for Infected Extra-articular Long Bone Fractures without Bone Loss

Management of infected extra-articular long bone fractures without bone loss remains a challenging orthopedic problem. Traditional methods involving external fixators can be associated with discomfort, pin site infections, and delayed union. Supercutaneous plating using metaphyseal locking plates offers a promising alternative. To evaluate the clinical and radiological outcomes of locking plate fixators as a definitive treatment for infected extra-articular tibial and femoral fractures without bone loss.

This prospective study included 15 patients treated between February 2018 and November 2019 at a tertiary care center. Inclusion criteria were extra-articular fractures without bone loss or intra-articular extension, and adequate wound management feasibility. All patients underwent thorough debridement and fixation using metaphyseal locking plates as external fixators following external fixator principles. Antibiotics were tailored based on intraoperative cultures and administered for 6 weeks. Patients were followed clinically and radiographically for fracture healing, complications, and functional outcome using the Knee Society score.

Of the 15 patients, 4 had distal femur fractures and 11 had tibial fractures. The mean follow-up was 9 months. Average union time was 8 months for femur and 3.9 months for tibia fractures. Two patients required autologous iliac crest bone grafting. Functional outcomes were excellent in 4 patients (26.6%), good in 7 (46.6%), fair in 3 (20%), and poor in 1 (6.7%), with all suboptimal outcomes noted in femur fractures. Six patients experienced screw tract infections, and one had a refracture following premature plate removal. No implant failure or loosening was observed.

Metaphyseal locking plate fixators can be effectively used as a definitive fixation method for infected extra-articular fractures without bone loss. The technique provides stable fixation, acceptable infection control, and promotes union with good patient compliance. Larger prospective studies are required to confirm these promising outcomes.