Supercutaneous locking compression plate in the treatment of infected non-union and open fracture of the leg

Introduction: Salvage of infected tibia and fibula non-union and severe open fractures is challenging and often requires staged treatment. We describe all cases that underwent supercutaneous plating of the leg as external fixation technique and assessed union rate, time to union, rate of infection clearance, and patient-reported outcome measures. Methods: This is a retrospective cohort study from a single level 1 trauma center. We included 19 patients that underwent supercutaneous plating—locking compression plate applied as external fixator—of the leg. Indications were: infected non-union of a pilon, cruris, or ankle fracture (n = 13); post-traumatic fistula draining osteomyelitis of the tibia (n = 3); infected mal-reduced subacute cruris fracture (n = 1); acute open pilon fracture (n = 1); and acute open cruris fracture (n = 1). Outcome measures were: union, time to union, infection clearance, the 36-item Short Form (SF-36) physical component summary scale (PCS) and mental component summary scale (MCS), and NRS pain scores. Results: Union was achieved in 88% of the patients after a median of 279 days [interquartile range (IQR) 154–440]. Infection clearance was achieved in 94% of the patients. The PCS (median 51, IQR 46–56, p = 0.903) and MCS (median 57, IQR 50–60, p = 0.241) do not differ from normative population values. NRS Pain score at rest was 0 on average (IQR 0–1), 2 on average when walking (IQR 0–4), and 1 on average when climbing stairs (IQR 0–2). Conclusion: Supercutaneous plating is a simple and reliable technical trick to bridge and stabilize a nonunion or fracture site while clearing an infection and have soft-tissues heal before subsequent definitive (internal)fixation and/or cancellous bone grafting. Reasonable union and infection clearance rates are achieved, and good functional outcome can generally be expected. Level of evidence: Therapeutic level III.