Functional Outcomes of Bicolumnar Plating in Schatzker Type V and VI Proximal Tibial Fractures: A Prospective Study

TL;DR

This study shows that using bicolumnar plating for certain tibial fractures leads to good recovery and functional outcomes.

Contribution

The study provides new evidence on the effectiveness of bicolumnar plating for Schatzker type V and VI tibial fractures.

Findings

Bicolumnar plating achieved fracture union with a mean time of 13.75 weeks.

Patients showed significant improvement in Modified Rasmussen Scores over time.

Postoperative complications were observed in 19 patients, but no major failures occurred.

Abstract

Background

Managing bicondylar intra-articular tibial plateau fractures resulting from high-energy trauma remains challenging, primarily due to complex fracture morphology and significant associated soft tissue injury, which contribute to a high risk of complications. Despite advancements in management, outcomes for unstable bicondylar fractures remain suboptimal. This study aimed to evaluate the functional outcomes and complications associated with internal fixation of bicondylar tibial plateau fractures using dual plating through two incisions.

Objectives

To assess the functional outcomes of surgical treatment for proximal tibial fractures (Schatzker types V and VI) managed with bicolumnar plating.

Materials and methods

A prospective clinical study was conducted from April 2023 to December 2024 at Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura. Thirty-one patients with Schatzker type V and VI proximal tibia fractures treated with bicolumnar plates were included. Functional outcomes were evaluated using the Modified Rasmussen Score at two weeks, six weeks, three months, and six months postoperatively.

Results

Significant improvement in Modified Rasmussen Scores was observed at all postoperative time points. All fractures achieved union with a mean time to union of 13.75 weeks. The average knee range of motion (ROM) ranged from 1.5° extension lag to 130° flexion (range: 0°-10° extension lag; 100°-135° flexion). The mean final Rasmussen functional score was 25.48. Postoperative radiographs showed a mean medial proximal tibial angle (MPTA) of 87.51° (range 82°-92°) and a mean posterior proximal tibial angle (PPTA) of 8.13° (range 4°-14°). Complications were noted in nineteen patients, but there were no cases of secondary loss of reduction, implant failure, malunion, or nonunion.

Conclusion

Dual locking plate fixation for bicondylar tibial plateau fractures offers a reliable and effective treatment strategy, ensuring rigid stabilization and facilitating favorable functional and radiological outcomes. Bicolumnar plating has proven to be particularly effective in the management of Schatzker type V and VI fractures, yielding excellent results when performed by skilled surgeons. Early rehabilitation, including the use of continuous passive motion (CPM), plays a crucial role in minimizing postoperative complications such as knee stiffness and promoting optimal joint mobility.

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