title: Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates.
abstract: BACKGROUND
  Dual plate fixation in comminuted bicondylar tibial plateau fractures remains controversial. Open reduction and internal fixation, specifically through compromised soft tissues, has historically been associated with major wound complications. Alternate methods of treatment have been described, each with its own merits and demerits. We performed a retrospective study to evaluate the functional outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a medial minimally invasive approach or a posteromedial approach.
  
  
  METHODS
  We treated 46 tibial plateau fractures Schatzker type V and VI with lateral and medial plates through an anterolateral approach and a medial minimal invasive approach over an 8 years period. Six patients were lost to followup. Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The functional outcome was evaluated according to the Oxford Knee Score criteria on followup.
  
  
  RESULTS
  Forty patients (33 men and 7 women) who completed the followup were included in the study. There were 20 Schatzker type V fractures and 20 Schatzker type VI fractures. The mean duration of followup was 4 years (range 1-8 years). All patients had a satisfactory articular reduction defined as ≤2 mm step-off or gap as assessed on followup. All patients had a good coronal and sagittal plane alignment, and articular width as assessed on supine X-rays of the knee in the anteroposterior (AP) and lateral views. The functional outcome, as assessed by the Oxford Knee Score, was excellent in 30 patients and good in 10 patients. All patients returned to their pre-injury level of activity and employment. There were no instances of deep infection.
  
  
  CONCLUSIONS
  Dual plate fixation of severe bicondylar tibial plateau fractures is an excellent treatment option as it provides rigid fixation and allows early knee mobilization. Careful soft tissue handling and employing minimal invasive techniques minimizes soft tissue complications.
authors.affiliation: Department of Orthopedics, Nova Specialty Surgery, Chennai, India.
authors.forename: G Thiruvengita
authors.initials: GT
authors.lastname: Prasad
authors.forename: T Suresh
authors.initials: TS
authors.lastname: Kumar
authors.forename: R Krishna
authors.initials: RK
authors.lastname: Kumar
authors.forename: Ganapathy K
authors.initials: GK
authors.lastname: Murthy
authors.forename: Nandkumar
authors.initials: N
authors.lastname: Sundaram
keywords: Dual plating; bicondylar; minimal invasive; tibial plateau