Tibial plateau fractures are intra-articular fractures involving a major weight-bearing joint and account for approximately 1% of all fractures in adults¹². These injuries commonly occur in the third to fifth decade of life and are frequently associated with high-energy trauma such as road traffic accidents³.

Schatzker classification remains the most widely used system for categorizing these fractures, with type V and VI representing bicondylar fractures involving both medial and lateral condyles and often associated with metaphyseal-diaphyseal dissociation⁴. These high-energy injuries contribute to approximately 20–40% of tibial plateau fractures and are frequently associated with severe soft tissue damage, comminution, and instability⁵⁻⁸.

Management of Schatzker type V and VI fractures is challenging due to the need for anatomical reduction, restoration of articular congruity, and preservation of surrounding soft tissues. Various surgical techniques have been described; however, dual plating has gained popularity due to its ability to provide stable fixation of both medial and lateral columns, allowing early mobilization and improved functional outcomes⁹.

Previous studies have demonstrated that dual plating offers superior biomechanical stability compared to single lateral plating and is associated with better alignment, reduced collapse, and improved functional recovery¹⁰⁻¹⁴. Therefore, the present study was undertaken to evaluate the functional and radiological outcomes of Schatzker type V and VI tibial plateau fractures treated with dual plating.

CASE PRESENTATION

A 42-year-old male presented with:

• Pain
• Swelling
• Inability to bear weight

Following road traffic accident.

Clinical findings:

• Knee swelling
• Tenderness
• Restricted movement
• No neurovascular deficit

Radiological evaluation confirmed Schatzker type VI fracture.

PRE-OPERATIVE RADIOLOGY

Figure 1: Pre-operative radiograph showing Schatzker type VI fracture.

INTRAOPERATIVE FINDINGS (DUAL PLATING)

Figure 2: Intraoperative image showing dual plating fixation.

POST-OPERATIVE RADIOLOGY

Figure 3: Post-operative radiograph demonstrating anatomical reduction.

REHABILITATION AND FUNCTIONAL OUTCOME

Figure 4: Functional outcome at final follow-up showing good range of motion.

METHODOLOGY / MANAGEMENT

• Supine position under tourniquet
• Temporary external fixation
• CT scan evaluation
• Definitive fixation with dual plating
• Drain removal after 48 hrs
• Knee mobilization from POD 4
• Non-weight bearing for 10 weeks

Follow-up:

• 2 weeks
• 1 month
• 3 months
• 6 months
• 1 year

Assessment:

• Modified Rasmussen functional score
• Modified Rasmussen radiological score

RESULTS

Functional Outcome

Functional Outcome:

• Excellent: 14 patients
• Good: 6 patients
• Fair/Poor: 0 patients

Radiological Outcome

• Majority scored 16–18
• Good anatomical alignment achieved

Overall Results

• Mean age: 42.9 years
• Mean ROM: 126°
• Union time: 20 weeks
• All patients returned to pre-injury status

Complications

• Knee stiffness: 6 cases (resolved)
• No infection
• No implant failure

DISCUSSION

High-energy bicondylar tibial plateau fractures (Schatzker type V and VI) are complex intra-articular injuries that pose a significant challenge to orthopedic surgeons due to associated soft tissue compromise, comminution, and instability¹⁻⁴. The primary goals of treatment include anatomical reduction, restoration of joint congruity, stable fixation, and early mobilization while minimizing complications such as infection, malalignment, and stiffness⁵⁻⁸.

In the present study, dual plating provided a stable construct that allowed early mobilization and resulted in good to excellent functional and radiological outcomes. These findings are consistent with the study by Prasad et al., who reported satisfactory functional outcomes in patients treated with dual plating for Schatzker type V and VI fractures⁹.

Barei et al. demonstrated that bicondylar fractures treated with dual plating using a two-incision technique showed improved fracture stability but were associated with potential complications if soft tissue handling was inadequate¹⁰. Similarly, Jiang et al. compared LISS plating with dual plating and found that dual plating provided better stability in complex bicondylar fractures, particularly in cases with medial column involvement¹¹.

Lee et al. reported that dual plating achieved better functional outcomes and alignment compared to unilateral lateral plating, emphasizing the importance of addressing both columns in bicondylar fractures¹². Furthermore, Yao et al. showed that dual plating significantly reduced the risk of varus collapse and malalignment compared to single plating techniques¹³.

Recent studies such as Haider et al. have also demonstrated that dual plating results in high rates of fracture union, improved knee range of motion, and satisfactory patient outcomes, further supporting its role as a reliable treatment modality¹⁴.

The advantages of dual plating include better visualization of fracture fragments, especially the posteromedial fragment, fixation of both medial and lateral columns, achievement of interfragmentary compression, and provision of a rigid construct that allows early knee mobilization. Early mobilization plays a crucial role in enhancing fracture healing, preventing joint stiffness, and improving functional recovery.

However, the procedure is technically demanding and requires careful preoperative planning and meticulous soft tissue handling to minimize complications. In the present study, complications were minimal and manageable, which correlates with existing literature emphasizing the importance of surgical expertise and timing of intervention.

Overall, the findings of this study reinforce that dual plating is an effective and reliable technique for managing Schatzker type V and VI tibial plateau fractures, providing stable fixation, facilitating early rehabilitation, and resulting in favorable functional and radiological outcomes.

Dual plating provides:

• Stable construct
• Better visualization of fragments
• Fixation of both medial and lateral columns
• Interfragmentary compression
• Early mobilization

Advantages of Dual Plating

1. Better visualization (especially posteromedial fragment)
2. Fixation of both columns
3. Interfragmentary compression
4. Rigid stability
5. Early knee mobilization

Advantages of Early Mobilization

1. Enhances fracture union
2. Prevents stiffness
3. Improves functional recovery

Complications like infection and compartment syndrome can be minimized by:

• Proper timing
• Gentle soft tissue handling
• Meticulous surgical technique

CONCLUSION

Bicondylar tibial plateau fractures treated with dual plating show:

• Good to excellent functional outcomes
• Excellent radiological alignment
• Stable fixation
• Early recovery

Dual plating remains a reliable and effective treatment modality for Schatzker type V and VI fractures. However, larger multicentric studies are required to validate long-term outcomes and complications.

Author Contributions

• 1) Vinay B. Patil: Study conception, surgical management, manuscript review
• 2) Santosh Shegedar: Data collection, literature review, manuscript drafting
• 3) Eshwar Masgal: Case documentation, imaging interpretation, follow-up
• 4) Nishant Melkundi: Data analysis, manuscript editing, formatting

Conflict of Interest

• 1) The authors declare no conflict of interest.

Funding

• 1) No external funding was received for this study.

Ethical Approval

• 1) Ethical approval was obtained from the Institutional Ethics Committee, and written informed consent was obtained from the patient for publication of this case report.

REFERENCES

1. Schatzker J. Fractures of the tibial plateau. In: The Rationale of Operative Fracture Care. 2005:447–469.
2. Marsh JL. Tibial plateau fractures. In: Rockwood and Green's Fractures in Adults. 8th ed. Wolters Kluwer; 2015:2303–2367.
3. Rudloff MI. Fractures of the lower extremity. In: Campbell's Operative Orthopaedics. Elsevier; 2013:2668–2724.
4. Marsh JL. Tibial plateau fractures. In: Rockwood and Green's Fractures in Adults. Wolters Kluwer; 2010:1782–1830.
5. Schatzker J. Fractures of the tibial plateau. In: The Rationale of Operative Fracture Care. 2005:447–469.
6. Marsh JL. Tibial plateau fractures. In: Rockwood and Green's Fractures in Adults. 8th ed. Wolters Kluwer; 2015:2303–2367.
7. Rudloff MI. Fractures of the lower extremity. In: Campbell's Operative Orthopaedics. Elsevier; 2013:2668–2724.
8. Marsh JL. Tibial plateau fractures. In: Rockwood and Green's Fractures in Adults. Wolters Kluwer; 2010:1782–1830.
9. Prasad GT, Kumar TS, Kumar RK, Murthy GK, Sundaram N. Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates. Indian J Orthop. 2013;47(2):188–194.
10. Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma. 2004;18:649–657.
11. Jiang R, Luo CF, Wang MC, Yang TY, Zeng BF. A comparative study of LISS fixation and double plating for bicondylar tibial plateau fractures. Knee. 2008;15:139–143.
12. Lee MH, Hsu CJ, Lin KC, Renn JH. Comparison of outcome of unilateral locking plate and dual plating in bicondylar tibial plateau fractures. J Orthop Surg Res. 2014;9:62.
13. Yao Y, Lv H, Zan J, Zhang J, Jiang D. A comparison of lateral fixation versus dual plating for bicondylar tibial plateau fractures. Injury. 2015;46:209–214.
14. Haider MA, Hossain MI, Ahmed W, et al. Functional outcome of Schatzker type V and VI tibial plateau fractures managed by dual plating. Int J Res Orthop. 2024;11(1):20–24.