Objective：This study aims to investigate the clinical effect of posterior plate in the treatment of middle and distal tibial fractures with anterior soft tissue injury. Methods：From July 2014 to June 2021, 16 cases of middle and distal tibial fractures with anterior soft tissue injury were treated, including 12 males and 4 females. Patients ranged in age from 20 to 54 years, with a mean age of 36.2 years.The causes of injury were traffic injury (n = 10) and heavy object injury (n = 6). All cases were treated by posterolateral approach and posterior tibial plate internal fixation. Postoperative efficacy was evaluated according to the American Association of foot and ankle Surgical Association score (AOFAS). Results:All cases were followed up for 8 to 23 months. The incisions healed in one stage and the fractures healed well. There were no complications such as failure of internal fixation or re-displacement of fractures. According to the AOFAS standard: 9 cases were excellent, 6 cases were good, 1 case was fair, and the excellent and good rate was 93.8%. Conclusion:Posterior approach and posterior plate internal fixation can be used as a reliable choice and effective supplement for the treatment of middle and distal tibial fractures with poor anterior soft tissue conditions. When choosing the treatment of this kind of fracture, it is still necessary to comprehensively consider the specific injury of the patient, the doctor""s experience and anatomical proficiency and other factors.