Single-Stage Externalized Locked Plating for Treatment of Unstable Meta-Diaphyseal Tibial Fractures

Biser Makelov, Dominic Mischler, Peter Varga, Theerachai Apivatthakakul, James W.A. Fletcher, Deyan Veselinov, Till Berk, Dimitur Raykov, Boyko Gueorguiev

Research output: Contribution to journalArticlepeer-review

1 Citation (SciVal)


(1) Background: Unstable meta-diaphyseal tibial fractures represent a heterogeneous group of injuries. Recently, good clinical results have been reported when applying a technique of externalized locked plating in appropriate cases, highlighting its advantage in terms of less additional tissue injury compared with conventional methods of fracture fixation. The aims of this prospective clinical cohort study were, firstly, to investigate the biomechanical and clinical feasibility and, secondly, to evaluate the clinical and functional outcomes of single-stage externalized locked plating for treatment of unstable, proximal (intra- and extra-articular) and distal (extra-articular), meta-diaphyseal tibial fractures. (2) Methods: Patients, who matched the inclusion criteria of sustaining a high-energy unstable meta-diaphyseal tibial fracture, were identified prospectively for single-stage externalized locked plating at a single trauma hospital in the period from April 2013 to December 2022. (3) Results: Eighteen patients were included in the study. Average follow-up was 21.4 ± 12.3 months, with 94% of the fractures healing without complications. The healing time was 21.1 ± 4.6 weeks, being significantly shorter for patients with proximal extra- versus intra-articular meta-diaphyseal tibial fractures, p = 0.04. Good and excellent functional outcomes in terms of HSS and AOFAS scores, and knee and ankle joints range of motion were observed among all patients, with no registered implant breakage, deep infection, and non-union. (4) Conclusions: Single-stage externalized locked plating of unstable meta-diaphyseal tibial fractures provides adequate stability of fixation with promising clinical results and represents an attractive alternative to the conventional methods of external fixation when inclusion criteria and rehabilitation protocol are strictly followed. Further experimental studies and randomized multicentric clinical trials with larger series of patients are necessary to pave the way of its use in clinical practice.

Original languageEnglish
Article number1600
JournalJournal of Clinical Medicine
Issue number4
Publication statusPublished - 17 Feb 2023

Bibliographical note

Funding Information:
The authors are not compensated, and there are no other institutional subsidies, corporate affiliations, or funding sources supporting this work unless clearly documented and disclosed. This research was funded by Trakia University–Stara Zagora, grant number 5/2019.

Data Availability Statement:
The datasets analyzed during the performance of the current study
are available from the corresponding author on reasonable request. In order to comply with the
requirements of the Ethics Committee, the image set is not available for request due to data privacy policies.


  • externalized locked plating
  • supercutaneous plating
  • unstable tibial fractures

ASJC Scopus subject areas

  • Medicine(all)


Dive into the research topics of 'Single-Stage Externalized Locked Plating for Treatment of Unstable Meta-Diaphyseal Tibial Fractures'. Together they form a unique fingerprint.

Cite this