Tibial shaft fracture plating is an operation to fix a fracture of the shinbone using a plate and screws applied to the bone surface. It is an alternative to intramedullary nailing and is chosen for specific fracture patterns or locations.
An incision is made over the fracture site on the medial (inner) or anterolateral aspect of the tibia. The fracture is reduced and a plate is applied to the bone surface. Minimally invasive percutaneous plate osteosynthesis (MIPPO) uses smaller incisions and a plate slid under the skin with screws placed through stab incisions. The operation takes one to two hours.
Plating is preferred for proximal and distal tibial shaft fractures (near the knee or ankle) where nailing may not provide adequate fixation, fractures extending into the joint, open fractures requiring access for debridement, and in specific fracture patterns not suited to nailing.
Intramedullary nailing is the standard for most tibial shaft fractures. Cast or functional brace may be used for undisplaced fractures.
Full-length tibial X-rays and CT if the fracture extends into a joint. Standard pre-assessment.
Anatomical reduction and stable fixation. MIPPO preserves the blood supply to the fracture, promoting healing.
The skin over the medial tibia is thin and vulnerable.
Leg swelling for several weeks.
The plate is palpable under thin skin.
The tibial shaft can be slow to heal. Risk approximately 5-10%.
Wound or deep infection. Risk is higher with open fractures.
A surgical emergency.
The plate may bend or break if union is delayed.
DVT despite preventive measures.
General or spinal anaesthesia.
Weight-bearing depends on fracture pattern — partial weight-bearing initially in most cases. Physiotherapy for knee and ankle range of motion. Full recovery four to nine months.
X-rays at six weeks, three months, and six months.
Plating is preferred for fractures near the joints (proximal or distal third), fractures extending into the knee or ankle joint, and certain open fracture patterns. Nailing remains the standard for most mid-shaft fractures.