Long-term outcomes of dual locking-plate fixation for bicondylar tibial plateau fractures via two mini-incisions: A prospective study.

BACKGROUND

Bicondylar tibial plateau fractures are complex injuries that frequently involve a posteromedial fragment and carry a high risk of post-traumatic osteoarthritis. However, long-term outcome data on dual locking-plate fixation are limited, particularly in Southeast Asian populations.

OBJECTIVE

The aim of this prospective study was to evaluate longitudinal clinical and imaging outcomes of bicondylar tibial plateau fractures managed with anterolateral and posteromedial locking plates via two mini-incisions.

METHODS

This prospective study included 55 patients treated with open reduction and dual locking-plate fixation via anterolateral and posteromedial mini-incisions. Outcomes included radiographic parameters, clinical function and complications.

RESULTS

The mean age was 45.4 ± 12.4 years; 60% of patients were male and motorcycle accidents accounted for 90.9% of injuries. Forty-five patients (81.8%) completed the 60-month assessment. Lateral plateau depression was reduced from 5.25 mm preoperatively to 1.00 mm postoperatively and was 2.17 mm at 5 years. KSS Knee peaked at 12 months (83.4 ± 8.2) and was 78.9 ± 8.8 at 5 years; the Rasmussen clinical score followed a similar trajectory. The overall complication rate was 23.6%, with a single deep infection (1.8%). Kellgren-Lawrence grade ≥ 2 increased from 14.5% of injured knees at 12 months to 53.3% at 60 months. Schatzker VI was associated with smaller Rasmussen clinical improvement than Schatzker V (-2.09; p = 0.023).

CONCLUSIONS

Dual locking-plate fixation through two mini-incisions provides favorable clinical and functional outcomes up to 5 years for bicondylar tibial plateau fractures; however, progressive post-traumatic osteoarthritis remains a long-term concern warranting surveillance.