Objective To investigate the differences in clinical efficacy between locking compression plate fixation and conventional plate-screw fixation in the treatment of limb fractures. Methods Patients with limb fractures admitted to Shahe Hospital of Changping District, Beijing between January 2022 and June 2025 were prospectively enrolled as research subjects. The patients were divided into the control group and the trial group at a 1∶1 ratio using the random-number table method. The control group was treated with conventional plate-screw internal fixation, while the trial group received locking compression plate fixation. A difference-in-differences model was constructed to analyze the effect of locking compression plate treatment on patients’ fracture score indicators. Logistic regression was used to analyze the impact of different treatment methods on curative effect. Results A total of 120 patients were included, with 60 cases in each group. At 6 months and 12 months after treatment, the limb swelling score and Visual Analogue Scale score of the trial group were lower than those of the control group, while the Radiographic Union Scale for Tibia score was higher than that of the control group (P<0.05). The results of difference-in-differences model analysis showed that the treatment plan was significantly correlated with the improvement of fracture score indicators (P<0.05). The fracture healing time of the trial group was shorter than that of the control group, and the postoperative complications were fewer than those of the control group (P<0.05). The comparison of clinical efficacy showed that the clinical efficacy of the trial group was better than that of the control group (P<0.05). Logistic regression analysis showed that the trial group could improve the total clinical effective rate. Subgroup analysis showed that the impact of different treatment methods on patients’ clinical efficacy was more significant in the subgroups of age ≥55 years and sedentary work (P<0.05). Conclusions Locking compression plate achieves favorable clinical efficacy in the treatment of limb fractures. It can effectively relieve postoperative pain and limb swelling, promote fracture healing, shorten healing time, and reduce the incidence of postoperative complications. Compared with conventional plate-screw internal fixation, it has obvious advantages in improving functional recovery and overall efficacy without significantly increasing medical costs, and possesses good value for popularization and application in clinical practice.