[objective] to investigate the clinical effect of locking plate external fixation in the treatment of middle and lower tibial open fracture after external fixation. [methods] from October 2015 to December 2018, 32 open fractures of the middle and lower tibia were retrospectively studied. According to the different surgical methods, they were divided into two groups: observation group (two-stage locking plate external) and control group (two-stage traditional open reduction and internal fixation), among which 17 cases were observed group and 15 cases were control group. The operative time, intraoperative blood loss, ankle Mazur score and postoperative complications were evaluated. [results] all patients in the observation group were cut. The screw loosening occurred in 1 case, but it did not affect the fracture healing. One patient in the control group showed redness exudation, delayed healing after repeated debridement, and delayed union of fracture in one patient. The 32 patients were followed up for 12 months and 36 months, with an average follow-up time of 29.8 months. At the last follow-up, the Mazur score of ankle function was 89.45 (7.21) in the observation group and 87.61 (5.21) in the control group. There was no significant difference between the two groups (p > 0.05). [conclusion] in the second stage, locking plate is used to treat the middle and lower tibia. Segment open fracture can effectively fix fracture, promote fracture healing, prevent incisional infection, postoperative joint function recovery is good, reduce postoperative complications, the clinical effect is satisfactory.