Comparing the efficacy of emergency bone cement plate internal fixation and external fixation for severe open tibial fractures during flap delay coverage: a retrospective study

Abstract Background Treatment of open tibial fractures remains a major challenge in clinical settings. The conventional method of temporary fracture fixation is external fixation. In this study, we aimed to evaluate the clinical efficacy and safety of antibiotic-loaded cement-coated plate (ACLP) internal fixation in the emergency management of patients with severe open tibial fractures undergoing delayed flap coverage. We hypothesized that emergency ACLP internal fixation can reduce the incidence of deep infection. Methods This retrospective study involved 73 patients with Gustilo type IIIB tibial fractures treated at our hospital between June 2016 and December 2023. Patients were divided into two groups based on the method of emergency temporary fixation: Group A ( n = 34) received ACLP internal fixation and Group B ( n = 39) received external fixation. Definitive internal fixation and wound repair were performed 2–7 d later. Results Bone union and soft-tissue repair were achieved in both groups. The incidence of deep infection was 11.76% in Group A and 15.38% in Group B, with no significant difference between groups (χ² = 0.012, p = 0.914). The Lower Extremity Functional Scale score was 55.62 ± 12.65 for Group A and 54.28 ± 12.15 for Group B (t = 0.460, p = 0.647). The physical component scores of the 36-item Short Form Health Survey were 78.12 ± 14.39 and 77.90 ± 13.17 for Groups A and B, respectively (t = 0.068, p = 0.946). The mental component scores were 76.00 ± 9.53 and 75.72 ± 13.21 for Groups A and B, respectively (t = 0.103, p = 0.918). No significant differences were observed in flap necrosis or bone union rates between the groups. Conclusions ACLP appears safe and effective as a temporary internal fixation method without flap transfer in the initial management of severe open tibial fractures.