Dual Plating for Comminuted Bicondylar Tibial Fractures
The tibial plateau fractures represent a group of injuries with complex patterns, intra-articular involvement, severe comminution and displacement. The objective of treatment is to attain articular reconstruction with a stable joint and a functional painless range of motion. Various treatment methods have been described for these complex fractures, each with its own merits and demerits. The present study was taken up considering the controversy in management, and scarcity of data regarding the use of dual plates and their functional outcome. Our aim was to analyse the surgical approaches, reduction and fixation techniques and to assess the functional outcome of dual plating in comminuted proximal tibia fractures.
47 patients (38 males and 9 females) with Schatzker type V (26 patients) or Schatzker type VI (21 patients) fractures of proximal tibia were treated with dual plating of upper tibia using anterolateral and posteromedial approach, and were followed up for a minimum of 30 months. All the patients had anatomical articular reduction, coronal and sagittal alignment and articular width maintained in the follow up X-rays. Outcome was measured using the Oxford knee scoring scale. 30 knees were scored as excellent, 11 as good and 6 as fair.
Open reduction and internal fixation with dual plating in complex proximal tibial fractures is an excellent treatment option, provided that the surgery is well planned with meticulously executed fixation and appropriate soft tissue management. Identifying and stabilizing the posterior coronal split fragments, which is not described in the Schatzker classification, and buttressing the medial side to prevent varus collapse are crucial in giving anatomical reduction and stability. As per our study dual plating can be considered as a good treatment approach for Schatzker type V and VI comminuted bicondylar tibial fractures.