Management of Orthopedic Plate Exposure: A Case Series Evaluating Advanced Wound Care and Delayed Hardware Removal

Background Plate exposure following open reduction and internal fixation (ORIF) poses significant challenges, including infection risk and impaired fracture healing. Traditional management often involves aggressive surgical interventions.​ Methods This retrospective case series examines seven patients treated between 2020 and 2025 who developed plate exposure after ORIF of lower extremity fractures. Management included local wound care with advanced dressings (Apligraf®, NuShield®), negative pressure wound therapy, targeted antibiotic therapy when indicated, and delayed hardware removal post-fracture consolidation.​ Results All patients achieved complete wound healing, with a mean closure time of 143 days. Radiographic union was confirmed in all cases except one asymptomatic nonunion. Antibiotics were administered in four cases, guided by clinical signs and microbiological findings. No infections were detected at the time of hardware removal.​ Conclusions A conservative approach utilizing advanced wound care techniques and delayed hardware removal can effectively manage plate exposure without necessitating early implant removal or flap coverage. This strategy may reduce patient morbidity and preserve fracture stability.