Introduction: Tibial fractures present substantial healing challenges because limited soft-tissue coverage, vulnerable blood supply, fracture complexity, and host-related factors increase the risk of impaired union. Although plate fixation restores alignment and stability, it may contribute to infection, nonunion, malunion, and implant-related complications. This study aimed to evaluate healing time and complications following tibial fracture plating from a pathologic perspective.

Material and methods: This descriptive cross-sectional study included 52 patients who underwent plate fixation for tibial fractures at Shahid Madani Hospital, Tabriz, selected through convenience sampling. Demographic, clinical, fracture-related, laboratory, operative, and postoperative data were collected from medical records and follow-up assessments. Healing time was determined using clinical and radiographic evidence of union, while postoperative complications, including infection, impaired union, malalignment, and implant-related failure, were documented.

Results: Patients with postoperative complications were older and had more severe injuries, including higher rates of open and comminuted fractures, longer time to surgery, and worse preoperative inflammatory and nutritional profiles (all significant variables, P<0.05). Healing time was markedly prolonged in complicated cases (23.2 ± 4.6 vs 15.9 ± 3.2 weeks, P<0.001). Independent predictors included age (OR=1.04), open fracture (OR=2.86), CRP (OR=1.17), surgical delay (OR=1.38), and operative duration (OR=1.21).

Conclusion: These findings indicate that postoperative complications after tibial plate fixation are driven by both fracture severity and adverse preoperative biological status. Early surgical management, control of inflammation, and optimization of hemoglobin and albumin levels may improve healing and reduce complication risk. Preoperative CRP and operative burden appear particularly valuable for risk stratification and perioperative decision-making.