Tibial plateau fractures involve the articular surface of the proximal tibia and account for approximately 1.2% of all fractures. These fractures commonly occur following high-energy trauma such as road traffic accidents and falls from height. Bicondylar fractures of the tibial plateau, classified as Schatzker type V and VI, are associated with significant articular disruption, metaphyseal comminution, and soft tissue injury.

The goals of treatment in tibial plateau fractures include:

• Restoration of articular congruity
• Maintenance of mechanical alignment
• Stable fixation of fracture fragments
• Early mobilization of the knee joint

Open reduction and internal fixation with plating allows direct visualization of fracture fragments and anatomical reconstruction of the articular surface. However, extensive surgical exposure may increase the risk of soft-tissue complications.

Hybrid external fixation uses the principle of ligamentotaxis and allows indirect fracture reduction while preserving soft-tissue integrity. This technique provides stable fixation with minimal surgical dissection and allows early mobilization.

Despite numerous studies evaluating these techniques, the optimal surgical method for bicondylar tibial plateau fractures remains controversial. Therefore, the present study aims to compare clinical and radiological outcomes of ORIF with plating versus hybrid external fixation in Schatzker type V and VI tibial plateau fractures.

MATERIALS & METHODS

Study Design

Prospective comparative study.

Study Setting

Department of Orthopaedics Gauhati Medical College and Hospital-Tertiary care teaching hospital.

Study Duration

Oct 2024 – Oct 2025.

Sample Size

30 patients.

Inclusion Criteria

• Age between 18–60 years
• Closed Schatzker type V and VI tibial plateau fractures
• Patients willing to participate in the study

Exclusion Criteria

• Open fractures
• Pathological fractures
• Polytrauma requiring emergency surgery
• Previous surgery around the knee

Surgical Procedeure

Group A – ORIF with Plating

• Open reduction using anterolateral or dual approach
• Anatomical reduction of articular fragments
• Fixation using locking compression plates
• Bone grafting when required

Group B – Hybrid External Fixator

• Percutaneous reduction of fracture fragments
• Hybrid external fixation using tensioned wires proximally and half pins distally
• Reduction achieved through ligamentotaxis

OUTCOME ASSESSSMENT

Functional outcome was assessed using the Modified Rasmussen Functional Score.

Radiological outcome was assessed using:

• Articular depression
• Condylar widening
• Varus/valgus alignment

Statistical Analysis

Data were analysed using SPSS version 26.0.

Continuous variables were expressed as mean ± standard deviation.

Categorical variables were analysed using the Chi-square test.

A p value <0.05 was considered statistically significant.

RESULT

Age Distribution

Mean age

Plating → 38.8 years

Hybrid → 35.26 years

Mode of Injury

Road traffic accidents were the most common cause.

Time to Radiological Union

Functional Outcome

Complications

CASE TREATED -ORIF WITH PLATING

CASE TREATED WITH HYBRID EXTERNAL FIXATOR

DISCUSSION

Bicondylar tibial plateau fractures represent complex injuries due to articular involvement and soft-tissue compromise.

The mean age distribution in the present study was comparable with studies by Barei et al. and Khatri et al., which also reported that these fractures occur predominantly in young adults exposed to high-energy trauma.

Radiological union occurred earlier in the hybrid fixation group. This may be attributed to preservation of periosteal blood supply and fracture hematoma, which facilitates biological fracture healing.

Functional outcomes were comparable between the two groups, consistent with findings reported by Bertrand et al., who demonstrated similar results between plating and hybrid fixation techniques.

Complication patterns differed between the two groups. Deep infections were more common in the plating group due to extensive soft-tissue exposure, whereas pin tract infections were more frequent in the hybrid fixation group but were generally manageable.

CONCLUSION

Both ORIF with plating and hybrid external fixation provide satisfactory clinical and radiological outcomes in Schatzker type V and VI tibial plateau fractures.

Hybrid fixation offers advantages such as:

• minimal soft-tissue disruption
• reduced blood loss
• earlier fracture union

However, ORIF with plating allows better anatomical reduction of the articular surface.

Therefore, treatment should be individualized based on fracture morphology, soft-tissue condition, and surgeon expertise

LIMITATIONS

• Small sample size
• Short follow-up duration
• Long-term complications such as post-traumatic osteoarthritis were not assessed

CLINICAL MESSAGE

Hybrid external fixation is a reliable alternative to plating in bicondylar tibial plateau fractures, particularly in patients with compromised soft-tissue conditions

Level of Evidence

Level III – Prospective Comparative Study

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