To explore whether the treatment with main and auxiliary plates can provide an alternative treatment for the middle and lower 1/3 tibial fractures.

Forty patients with mid-lower 1/3 tibial fractures admitted to the Second Hospital of Shanxi Medical University Orthopedics single team between June 2015 and July 2021 were retrospectively collected, with AO classification of 42A (11 cases), 42B (5 cases) and 42C (24 cases). There were 33 males and 7 females; 21 left-sided cases and 19 right-sided cases; ages ranged from 18 to 67 years, with a mean age of (43.4±14.3) years. All patients were treated with main and auxiliary plates in the same way by the same team. Post-operative rehabilitation exercises were given to the patients and regular follow-ups were carried out after discharge. The fracture alignment and fracture healing were observed and recorded, complications and adverse effects were recorded. The ankle joint function was analyzed with the AOFAS score of the ankle. Patients were followed up until the fracture healed completely.

Thirty-five patients were followed up and 5 patients were lost. The follow-up period was 4 to 33 months. The fracture healing time was 12 to 20 weeks, the median was 16 (14, 18) weeks. The AOFAS score of ankle-hindfoot showed an excellent rate of 97.1% for the treatment of mid-lower 1/3 tibial fractures. One patient had a mildly infected skin ulceration of the lateral malleolus and the wound healed after dressing changes and anti-inflammatory treatment. One patient with Gustilo type I tibial fracture accompanied with ulceration of anterior tibial skin and exposed internalfixation, wound healed after dressing changes and sutures. One patient got tibial valgus deformity (valgus angle approximately 8°) which has no serious effect on walking. Importantly, in their last follow-ups, the fracture position was good, and the X-ray showed that the fracture healed, and the patients could walk without pain and support.

In the treatment of the middle and lower 1/3 tibial fractures, the main and auxiliary plates technique provides a solid internal fixation, effectively preventing the displacement of the fracture end so the patients can carry out rehabilitation exercises earlier and complications such as ankle stiffness are reduced. Meanwhile, it reduces the incidence of delayed fracture healing and nonunion. It has achieved good clinical results.