Spanning External Fixation Research Articles

The effect of spanning external fixation on entrapped structures in tibial pilon fractures.

Pilon fractures are often complex injuries involving severe soft tissue injury. Studies have shown pilon fractures may entrap soft tissue structures between fracture fragments. Staged fixation of pilon fractures with spanning external fixation (SEF) is important for soft tissue rest and plays an important role in the management of these injuries. While SEF has been shown to promote soft tissue rest prior to definitive fixation, no studies have shown the effect SEF has on entrapped structures (ES). The purpose of this study was to evaluate how SEF effects ES in pilon fractures. A retrospective review of 212 pilon fractures treated at our institution between 2010 and 2022 was performed. Patients with a CT scan pre-SEF and post-SEF met inclusion criteria. CTs were reviewed to characterize ES in pre- and post-SEF imaging. Of the 19 patients with ES identified on CT pre-SEF, seven (36.8%) had full release of ES post-SEF and 12 (63.2%) had no release of ES. The posterior tibial tendon was the most commonly ES and remained entrapped in 62.5% of cases. Only 25% of 43-C3 fractures had release of ES post-SEF, while 100% of 43-C1 and 43-C2 fractures demonstrated complete release of ES post-SEF. Entrapped structures in pilon fractures are likely to remain entrapped post-SEF, with only one-third of our cohort demonstrating release. In 43-C3 patterns, if ES are identified on CT pre-SEF, surgeons should consider addressing these either through mini open versus open approaches at the time of SEF as they are likely to remain entrapped post-SEF.

Outcome Assessment of Ankle Spanning External Fixator with Limited Internal Fixation for Distal Tibial Extra Articular Fractures

Background: Road traffic accident claims the lives of almost 1.35 million individuals every year. Because of its subcutaneous arrangement, long bones, particularly the tibia, are usually fractured in these accidents. Since the late 1980s, external fixation with moderate interior fixation has increased. Extra-articular distal tibia fractures generally result from complex, high-energy trauma, which frequently includes accompanying fibular fractures and soft tissue injuries. Method: This is a Hospital-based Prospective Interventional type of study, which include 54 patients, all patients were included in the study of the Orthopaedic department of S.M.S. (Sawai Man Singh) Medical College and attached hospitals in Jaipur Rajasthan, India. The most common trauma mode was road traffic accidents between October-2018 to march-2021. Results: External fixation was used on all fifty-four patients, with or without limited internal fixation. Thirty-eight (70%) of the fifty-four fractures were open, while sixteen (third) were closed. After the operation, the fractures healed in an average of 15.5 weeks. Although none of the patients received bone grafting during the initial treatment of the fracture, twelve patients had bone grafting six weeks after the initial treatment. Mazur’s scoring, modified by Teeny and Wiss, was used to score ankle functions. Angulation of more than 5 degrees is a sign of malunion. Conclusion: External fixation with or without limited internal fixation is an additional option for treating extra-articular distal tibial fractures. Open reduction and plate osteosynthesis have similar union rates.

Management of Comminuited Intra/Juxta Articular Fracture of Distal Radius Using Bridging External Fixator

Background: Distal radius fractures are the third most common osteoporotic fractures and are frequently treated in emergency department. They have a trimodal peak of occurrence and there has been a significant increase in incidence of involvement in elderly females and young males. Management of these fractures comes with lots of treatment options and challenges to provide good functional outcome. This prospective study was done for the management of communited intra/juxta articular fractures of distal end radius using a bridging external fixator on 25 patients. The principle of ligamentotaxis was used for alignment of fracture fragments and wrist spanning external fixator was used to maintain the fracture reduction.Methods:25 patients of either sex with age group 16 to 80 years were taken from the orthopedic department. After proper primary care, cases were classified using Fernandez classification, and posted for surgery as soon as investigations and fitness were taken.Results:Patients involved in the study were in range of 16 to 78 years with 16 patients having dominant side with road traffic accident as leading cause.Radiological union was seen at an average of 7.3 weeks, 4 patients had superficial pin tract infection, 3 patients had stiffnes and a single case had malunion. Conclusions:Modified clinical scoring system of Green and O’Brien was used to evaluate the overall functional results which showed excellent to good results in 84% of cases. Hence, properly planned and executed bridging external fixator is an easy, cost-effective and reliable treatment modality through the “Principle of Ligamentotaxis”.

Staged surgical treatment of open Lisfranc fracture dislocations using an adjustable bilateral external fixator: A retrospective review of 21 patients.

The aim of this study was to assess the early operative results of a staged progressive reduction technique using a bilateral external fixator in the treatment of patients with open Lisfranc fracture dislocations. In this retrospective study, 21 patients (5 women and 16 men; mean age=44.4 years; age range=24 to 69 years) with open Lisfranc fracture dislocations were included. All the patients were treated in a staged manner from 2012 to 2015. The mean follow-up was 15.4 months (range=12 to 24 months). A two-stage surgical protocol was performed for each patient. At the first stage, a bilateral spanning external fixator was applied across the injured Lisfranc joint, and the length of the disrupted columns was restored by distraction process. Vacuum-assisted closure was used if required. At the second stage, the external fixator was removed, and open reduction and internal fixation were carried out. The time interval between the first and second stages and postoperative complications were documented. To assess the functional status of the patients, the visual analog scale (VAS) and the American Orthopaedic Foot - Ankle Society (AOFAS) midfoot scale were measured at the final follow-up. Radiographic parameters indicating the alignment of the midfoot after the second operation were examined. Deep infection in one patient and superficial infection in 2 patients were observed. Venous thrombosis was detected in 3 patients. The mean interval between the first and second stages was 18.6 days (range=8 to 48 days). The first metatarso-cuneiform step-off (p=0.002) and the second metatarso-cuneiform step-off (p=0.000) significantly improved at the final follow-up. The mean VAS score was 2.4 (range=0-5), and the mean AOFAS score was 76.3 (range=63 to 97). Primary arthrodesis was performed in seven patients, and six of the remaining 14 patients developed post-traumatic arthritis. With a low risk of complications, the staged progressive reduction protocol using an adjustable bilateral external fixator can be an effective treatment to achieve and maintain anatomic reduction for patients with open Lisfranc fracture dislocations in a short-time follow-up. Level IV, Therapeutic study.

Posterolateral plating is a safe alternative for the treatment of distal tibial fractures

IntroductionWe assessed the outcome and safety of posterior plating of distal tibial fractures. MethodsWe conducted a retrospective case series at a Level I trauma center. Seventy-four consecutive patients with distal tibial fractures treated with anatomically contoured 3.5-mm T-shaped locking compression plate using a posterolateral approach from January 2008 through April 2018 were included in the study. The mean patient age was 48 years (range, 18−87 years). Fifty-nine percent of the patients were male patients, 47% of the fractures were open fractures; and 27% of the patients had multiple traumatic injuries. Eleven fractures were AO/OTA type 42, 22 were type 43A, and 41 were type 43C. Sixty-two (84%) patients were treated with initial spanning external fixation (median time, 23 days) and staged open reduction and internal fixation. The main outcome measure was unplanned reoperation to address implant failure, nonunion, deep surgical site infection, or symptomatic implant. ResultsOverall risk of unplanned reoperation was 15% (11 of 74 patients, 95% confidence interval, 9%–25%). Four (5%) reoperations were for nonunion, three (4%) were for surgical site infection, two (3%) were for infected nonunion, and two (3%) were for implant prominence. Loss of alignment >10 degrees occurred in one patient who underwent unplanned reoperation for nonunion. No plate breakage occurred. Median time to reoperation was 221 days (range, 22–436 days). Only one other complication was noted: wound dehiscence associated with the posterolateral approach, which was treated with irrigation and débridement and a 6-week regimen of oral antibiotics. ConclusionsUse of a posterolateral approach with a pre-contoured locking compression T-plate for the treatment of distal tibial fractures led to reasonable outcomes with an acceptable risk of unplanned reoperation, even with a high proportion of open fractures commonly staged with external fixation.

Management of open complex tibial plateau fractures by Ilizarov fixator: average follow-up of 8.5 years

Introduction Open tibial plateau fractures are associated with significant soft tissue injuries which increase the risks of complications and their management is highly challenging. Ilizarov external circular fixation is an ideal method of treatment when extensive soft tissue dissection and internal fixation are contraindicated. This retrospective study aimed to evaluate the mid-term results of managing open complex tibial plateau fractures with Ilizarov fixator. Patients and methods The study included 27 patients with open tibial plateau fractures (Schatzker types V and VI) with a mean age of 40.56 years. They included 17 men and 10 women. Sixteen fractures were of open type III-A and 11 were type III-B according to the Gustilo classification. Seven cases had associated injuries. Five patients had previous temporary spanning external fixation. Three patients were diabetics. Above knee frame extension was done in 14 cases. Assisted wound closure by the frame was done in three cases. Results All fractures were fully united with a mean fixator period of 18.37 weeks. The average follow-up duration was 8.52 years. No patient developed a deep infection. According to the ASAMI score, the results were evaluated as excellent in nine patients, good in 14 patients, and fair in four patients. The overall result was judged as satisfactory by all patients. Conclusion The treatment of complex tibial plateau fractures with the Ilizarov fixator is a safe, versatile, and an effective treatment option, and produces good functional results. It also allows early full weight-bearing and good rehabilitation.

One-step Management of Severely Deformed, Long-Neglected Club Feet

Category: Other Introduction/Purpose: Early management of the club foot using the Ponsetti technique has almost eliminated severe residual deformities from this problem. Unfortunately, in remote regions of the world patients may not have been afforded the benefits of this technique. The consequences are severely deformed, long-neglected foot deformities. Interventions to mitigate this problem have included talectomies, osteotomies, tendon transfers, gradual corrections using Ilizarov principles and as a last resort, transtibial amputations. All have undesirable features such as inadequate corrections with residual deformities, need for additional surgeries, intensive post-operative management and/or need for custom orthotics or prostheses. We propose a one-stage, single setting approach to this problem that fully realigns the foot and requires minimum of post-operative management. Methods: During a 2017 humanitarian mission to Vietnam, six patients with severely deformed, long-neglected club feet were managed at a remote orthopaedic rehabilitation facility using our one-stage, single surgery approach. The six-step procedure included: 1) Percutaneous tri-hemisections (Hoke) of the Achilles tendon, 2) Excision of lateral ulcers/bursas, 3) Minimally invasive releases of all constricting soft tissues structures, 4) Closing wedge osteotomy at apex of deformity, 5) Manual reduction to achieve plantigrade foot, and 6) Maintenance of correction with temporary spanning external fixation in five patients and percutaneous Steinmann pins in a four-year old patient. No tendon transfers were done. No tourniquets or perioperative antibiotics were used with these minimally invasive and percutaneous interventions. At six weeks, the external fixation was removed, walking casts were applied with minimal manipulations to optimally position the feet. At 12 weeks the casts were removed, patients allowed to use footwear of their choosing. Results: Follow-ups initially obtained weekly, then monthly through e-mails by a co-author fluent in Vietnamese were supplemented with photographs. Near-plantigrade feet axially aligned with the leg were obtained with all the initial corrections. By 48 hours pain was reported as minimal even though marked tension occurred across intact joint capsules in order to achieve the corrections. One skin, pin tract infection was reported that resolved once the pin was removed. Follow-up information at six months report that the corrections have been maintained with high satisfaction in all patients. Conclusion: Our innovative approach to deformed, neglected club feet is supported by appreciating the biomechanics of the problems. Dynamic deforming forces (tendons and muscles) must be released. Tendon transfers are inadequate to correct contractures. Bony deformities must be osteotomized. Viscoelasticity of ligaments and joint capsules deform with time and need not be released; corrections initially obtained using the fixators become permanent with time. Our experiences support the use of our approach for the patient population with which we dealt and suggest that earlier soft tissue releases of dynamic deforming forces be done in conjunction with the Ponsetti technique.

An evolution in the management of fractures of the ankle

There has been an evolution recently in the management of unstable fractures of the ankle with a trend towards direct fixation of a posterior malleolar fragment. Within these fractures, Haraguchi type 2 fractures extend medially and often cannot be fixed using a standard posterolateral approach. Our aim was to describe the posteromedial approach to address these fractures and to assess its efficacy and safety. We performed a review of 15 patients with a Haraguchi type 2 posterior malleolar fracture which was fixed using a posteromedial approach. Five patients underwent initial temporary spanning external fixation. The outcome was assessed at a median follow-up of 29 months (interquartile range (IQR) 17 to 36) using the Olerud and Molander score and radiographs were assessed for the quality of the reduction. The median Olerud and Molander score was 72 (IQR 70 to 75), representing a good functional outcome. The reduction was anatomical in ten, with a median step of 1.2 mm (IQR 0.9 to 1.85) in the remaining five patients. One patient had parasthaesiae affecting the medial forefoot, which resolved within three months. We found that the posteromedial approach to the ankle for the surgical treatment of Haraguchi type 2 posterior malleolar fractures is a safe technique that enables good visualisation and reduction of the individual fracture fragments with promising early outcomes. Cite this article: Bone Joint J 2017;99-B:1496-1501.

The use of locked plate as a definitive fixation for open supracondylar fracture of the femur with partial bone loss in polytraumatized patients

Background Open supracondylar fractures of the femur are complex injuries usually presenting in a polytraumatized patient. Partial circumferential bone loss may result at the time of injury or during debridement. The way in which the fracture is treated has a substantial influence on the local mechanical and biological environment, which in turn will influence the quantity and quality of the osteogenic response. Although early skeletal stabilization can stop the cycle of injury, remove nidus for infection, and halt ongoing hemorrhage, it may be prudent to delay definitive surgery until the patient’s general condition is optimized. Meanwhile, debridement and a preliminary spanning external fixator is used to stabilize the fracture. The use of a locked plate for the fixation of supracondylar fracture of the femur with partial bone loss creates a rigid biomechanical environment needed for healing and maintenance of alignment until fracture healing. Patients and methods Eighteen patients with open supracondylar fracture of the femur were treated between January 2009 and June 2011. All patients were treated surgically within the first 24 h. Radical soft tissue and bone debridement was performed. Thirteen patients underwent definitive fracture fixation using a laterally placed locked distal femur plate. Five patients had their fractures primarily stabilized by an external fixator until improvement of their general condition. Results Bone healing was obvious on follow-up radiographs in 10 patients without the need for supplementary surgical procedures at a mean of 16 (12–20) weeks. Seven patients with no progressive radiologic healing by 20 weeks’ follow-up underwent an iliac crest cancellous bone graft; healing was then realized radiologically after a mean of 12 (8–18) weeks. Using the IOWA knee functional score for final patient assessment, we found excellent results in 14 patients, good results in three patients, and fair results in one patient. Conclusion Generally stable polytraumatized patients should be treated with thorough initial debridement, local antibiotics, and early definitive fracture fixation using a locked distal femur plate. Critically unstable patients with hemorrhagic shock are to be treated with damage control until improvement in their general condition. Bone graft is to be delayed for 20 weeks as many fractures would successfully heal by that time, even with partial bone loss.

Management of high-energy tibial pilon fractures.

Tibial pilon fractures result from high-energy trauma unlike usual ankle fractures. Their management provides numerous challenges to the orthopaedic surgeon including obtaining anatomic reduction of articular surface and the management of associated soft tissue injuries. This article aims to review major advances and principles that guide our practice today. We also discuss a treatment algorithm based on a staged approach to the fracture: initial spanning external fixation followed by definitive fixation.

Staged protocol for initial management of the dislocated knee

The purpose of this study was (1) to describe a staged protocol for management of the dislocated knee and (2) to describe clinical and functional outcomes for patients who received initial spanning external fixation as part of this protocol. Nine knees in 9 patients, consisting of 6 males and 3 females, mean age 30.4 (range 19-44) years with diagnosis or presumption of knee dislocation were treated with a protocol of stabilization with external fixator. Mean follow-up was 24 (range 13-42) months. Indications for spanning external fixation included significant vascular injury, gross instability on examination with failure to maintain joint reduction, open knee dislocation, inability to tolerate mobilization in a brace. The standard protocol involved vascular examination including ankle-brachial index, ligamentous examination (under anesthesia when applicable), stabilization with temporary joint spanning external fixator, thromboprophylaxis, reconstructive knee surgery, and standard rehabilitation. Mean range of motion (ROM) was 97.4° (range 80°-150°, SD 20.75, median 127.5). Median IKDC score was 80 (range 30-95), and mean Lysholm score was 76.7 (range 46-95). Heterotopic ossification (HO) was noted in 4 knees (44%). The treatment algorithm utilized in this series for management of the dislocated knee demonstrated satisfactory clinical and functional outcomes. This staged protocol provides a management option for those patients who may be best served with initial spanning joint external fixation. Larger prospective studies are needed to fully understand the merit of staged protocols in this setting.

Incidence of Deep Venous Thrombosis After Temporary Joint Spanning External Fixation for Complex Lower Extremity Injuries

The purpose of this study was to determine the incidence of deep venous thrombosis (DVT) in a prospective protocol of early spanning external fixation with the concurrent use of low-molecular weight heparin (LMWH) in patients with high-energy lower extremity trauma. Three level I trauma centers. Prospective observational study. One hundred thirty-six consecutive patients with 151 complex lower extremity injuries were treated with a protocol of immediate joint spanning external fixation application and LMWH administration within 24 hours of admission. A total of 143 external fixators were applied. Early patient mobilization was encouraged and possible due to the skeletal stability provided by the external fixator. There were 87 men and 49 women with a mean age of 43 years. There were 62 proximal tibia fractures (Orthopaedic Trauma Association [OTA] Fracture Classification 41), 4 tibial shaft fractures (OTA 42), 49 distal tibia-fibula fractures (OTA 43, 44), 14 femur fractures (OTA 32, 33), 8 calcaneus fractures (OTA 73), 10 knee dislocations, and 4 talus fracture dislocations. Forty-eight injuries (32%) were open. Temporary joint spanning external fixator placement, LMWH administration, and early mobilization within 24 hours of admission. Duplex ultrasonography of the bilateral lower extremities within 1 day to 3 days before fixator removal and definitive fixation procedure. Presence of DVT on duplex ultrasound examination. Duplex ultrasonography was negative for DVT in all but three patients for an incidence of 2.1% (3 of 143 fixators). There were no bleeding complications secondary to the use of LMWH while the temporary external fixator was in place. The incidence of DVT in patients treated with a protocol of early joint spanning external fixation and LMWH administration does not exceed historical controls. The early restoration of limb length, alignment, and stability allows early mobilization, which may contribute to the prevention of DVT.

Early Limited Internal Fixation of Diaphyseal Extensions in Select Pilon Fractures: Upgrading AO/OTA Type C Fractures to AO/OTA Type B

Fractures of the tibial pilon may present an array of problems and potential complications. Staged treatment with initial spanning external fixation of the ankle has proven to be a successful strategy for the treatment of these difficult fractures in many cases. A subset of the tibial pilon fractures, with an oblique extension to the diaphysis may constitute a treatment problem, as these long fractures may be difficult to reduce at the time of definitive fixation, often 1-3 weeks post-injury due to interposed soft tissues, hematoma and/or early callus. Anatomic reduction of this fracture may thus require more extensive dissection than might be desirable in this injury. We offer a technique to assist in the treatment of the subset of these difficult fractures. In appropriate cases, a small fragment plate may be applied to the diaphyseal component of the fracture in an anti-glide type plate application, through a small incision proximal to the area of greatest injury. This re-establishes the length, rotation and alignment of this fragment which is commonly attached to either the Chaput anterolateral or the Volkmann posterolateral fragment. It additionally provides the intimate contact that may favor early union or minimize the need for secondary procedures. The fracture is thereby converted from a complete articular AO/OTA 43-C type pattern to a partial articular, or AO/OTA 43-B type pattern.

Staged Management of High-Energy Proximal Tibia Fractures (OTA Types 41)

This study evaluated the use of a staged protocol involving temporary spanning external fixation and delayed formal definitive fixation in the management of high-energy proximal tibia fractures (OTA types 41) with regard to soft-tissue management, development of complications, and functional outcomes. Two level-one trauma centers and a tertiary care orthopaedic center. Fifty-three patients with 57 high-energy tibial plateau fractures. The authors instituted a protocol of immediate placement of knee spanning external fixation with management of soft-tissue injuries for all high-energy proximal tibia fractures. Between August 1999 and May 2002, 62 consecutive patients with 67 high-energy proximal tibia fractures (OTA types 41A, B, C) underwent temporary knee spanning external fixation on the day of admission. Nine patients with 10 fractures who transferred care after initial stabilization or sustained an extraarticular fracture were excluded. The remaining 53 patients with 57 fractures underwent repair of articular fractures and meta-diaphyseal fracture repair with plates and screw constructs or conversion to a ring fixator. These patients had a mean age of 47 years (standard deviation (SD), 14). Of these 53 patients, 42 (79%) were men and 11 (21%) were women. Characteristics of the 57 fractures were: 42 Schatzker VI (74%), 12 Schatzker V (21%), 2 Schatzker IV (4%), and 1 Schatzker II (2%). There were 41 closed fractures and 16 open fractures. (One patient had bilateral fractures with 1 extremity open and 1 closed). Orthopaedic evaluation at latest follow-up included a clinical and radiographic examination and functional outcome measurement with the Western Ontario McMaster functional knee score (WOMAC). Eight patients with 8 fractures were lost to follow-up. This left 45 patients with 49 fractures with a mean follow-up of 15.7 (SD, 5.7; range, 8-40) months. Complications included 3 (5%) deep wound infections, 2 (4%) nonunions, and 2 patients (4%) with significant knee stiffness (<90 degrees). Nine patients (16%) underwent additional surgery after definitive skeletal stabilization related to their injury. Range of knee motion at final follow-up was 1 degrees (SD, 4) to 106 degrees (SD, 15). The mean WOMAC was 91 (SD, 55). Poor results did not correlate with demographic or injury characteristics. We had a relatively low rate of wound infection in these complex injuries (5% overall). There was only 1 wound problem in our subset of patients with closed fractures and 2 infections in those with open fractures. One downside of this technique may be residual knee stiffness. The benefits of temporizing spanning external fixation include osseous stabilization, access to soft tissues, and prevention of further articular damage. Our relatively low rates of complications in patients who sustain high-energy proximal tibia fractures and the access this technique affords in open fractures and those with compartment syndrome lead us to recommend this technique in all high-energy intra-articular and extra-articular fractures of the proximal tibia. This study supports the practice of delayed internal fixation until the soft-tissue envelope allows for definitive fixation.

Open fractures of the calcaneus: a review of treatment and outcome.

The aim of this study was to evaluate the functional and clinical outcome of patients with open calcaneus fractures and to determine what factors were associated with these outcomes. Retrospective review of 2 level 1 prospective databases. SETTING/PATIENTS/PARTICIPANTS: All patients admitted with an open calcaneal fracture to 2 level 1 trauma units between January 1, 1987 and April 1, 1996 were identified. Data regarding demographics, injury characteristics, and treatment and complications were documented using a standardized data abstraction form. Radiographs were reviewed to document the fracture type according to Essex-Lopresti. For those patients who had computed tomography scans available, the Sanders et al classification was applied and documented. Patients were contacted and asked to return for follow-up evaluation including the American Orthopaedic Foot and Ankle Society ankle/hindfoot score, the Maryland Foot Score, and the Short Form 36 (SF-36). For patients not willing to return for examination, the questionnaires were completed over the telephone, and the objective scoring components were assigned to lowest score possible. Of 177 calcaneal fractures in patients treated as inpatients during the study period, we identified 30 open fractures in 29 patients. Twenty-seven patients had associated injuries. Two patients underwent amputation within 24 hours due to severe crush injury. Following urgent debridement, soft tissues were closed primarily (22 fractures) or with split thickness skin grafting (4 fractures) and free flap coverage (2 fractures); temporary spanning external fixation was used in 3 patients. Definitive fracture care was at the discretion of the treating surgeon and consisted of closed reduction without fixation (10 fractures), open reduction and bone grafting (1 fracture), minimal Kirschner wire (K wire) fixation (12 fractures), and formal lateral open reduction and internal fixation (5 fractures). There were no late amputations. There were no deep infections. Twenty-one of the 28 patients with salvaged limbs returned for follow-up evaluation, and 3 additional patients agreed to be interviewed by telephone. The average time to follow-up was 49 months with a range of 25 to 106 months. The overall American Orthopaedic Foot and Ankle Society ankle/hindfoot scores and Maryland Foot Scores were fair to poor. The average SF-36 results were within 1 standard deviation of published Canadian norms. Worse function was observed in patients with plantar wounds. Severely comminuted fractures had the worst function, whereas single joint depression injuries had the best functional outcome. Infection is uncommon following open calcaneus fractures treated with aggressive soft tissue management. Patients with plantar wounds and comminuted fractures are expected to have particularly poor functional results.

Extreme nailing of the tibia

We assessed the outcome and safety of posterior plating of distal tibial fractures.We conducted a retrospective case series at a Level I trauma center. Seventy-four consecutive patients with distal tibial fractures treated with anatomically contoured 3.5-mm T-shaped locking compression plate using a posterolateral approach from January 2008 through April 2018 were included in the study. The mean patient age was 48 years (range, 18−87 years). Fifty-nine percent of the patients were male patients, 47% of the fractures were open fractures; and 27% of the patients had multiple traumatic injuries. Eleven fractures were AO/OTA type 42, 22 were type 43A, and 41 were type 43C. Sixty-two (84%) patients were treated with initial spanning external fixation (median time, 23 days) and staged open reduction and internal fixation. The main outcome measure was unplanned reoperation to address implant failure, nonunion, deep surgical site infection, or symptomatic implant.Overall risk of unplanned reoperation was 15% (11 of 74 patients, 95% confidence interval, 9%–25%). Four (5%) reoperations were for nonunion, three (4%) were for surgical site infection, two (3%) were for infected nonunion, and two (3%) were for implant prominence. Loss of alignment >10 degrees occurred in one patient who underwent unplanned reoperation for nonunion. No plate breakage occurred. Median time to reoperation was 221 days (range, 22–436 days). Only one other complication was noted: wound dehiscence associated with the posterolateral approach, which was treated with irrigation and débridement and a 6-week regimen of oral antibiotics.Use of a posterolateral approach with a pre-contoured locking compression T-plate for the treatment of distal tibial fractures led to reasonable outcomes with an acceptable risk of unplanned reoperation, even with a high proportion of open fractures commonly staged with external fixation.