Senthurvelan Ajayguru, Nayak Ashok, Biradar Ravikumar, Bulagond Anil, Kenganal Prashant, Kulkarni Srikant, Patil Sahebagouda
Department of Orthopedics, Shri B. M. Patil Medical College, Hospital and Research Centre, Bharatiya Lingayat Development Educational Association (Deemed to be University), Vijayapura, IND.
Cureus. 2025 Jun 19;17(6):e86399. doi: 10.7759/cureus.86399. eCollection 2025 Jun.
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.
背景 处理由高能创伤导致的双髁关节内胫骨平台骨折仍然具有挑战性，主要是由于骨折形态复杂以及伴有严重的软组织损伤，这导致并发症风险很高。尽管在治疗方面取得了进展，但不稳定双髁骨折的治疗效果仍然不尽人意。本研究旨在评估通过两个切口使用双钢板内固定治疗双髁胫骨平台骨折的功能结果和并发症。
目的 评估采用双柱钢板治疗的胫骨近端骨折（Schatzker V型和VI型）的手术治疗功能结果。
材料和方法 2023年4月至2024年12月在维贾亚普拉的什里·B.M.帕蒂尔医学院、医院和研究中心进行了一项前瞻性临床研究。纳入了31例采用双柱钢板治疗的Schatzker V型和VI型胫骨近端骨折患者。在术后两周、六周、三个月和六个月使用改良Rasmussen评分评估功能结果。
结果 在所有术后时间点，改良Rasmussen评分均有显著改善。所有骨折均实现愈合，平均愈合时间为13.75周。膝关节平均活动范围（ROM）从伸直滞后1.5°到屈曲130°（范围：伸直滞后0°-10°；屈曲100°-135°）。最终Rasmussen功能评分平均为25.48。术后X线片显示胫骨近端内侧角（MPTA）平均为87.51°（范围82°-92°），胫骨近端后侧角（PPTA）平均为8.13°（范围4°-14°）。19例患者出现并发症，但没有出现二次复位丢失、植入物失败、畸形愈合或不愈合的病例。
结论 双髁胫骨平台骨折的双锁定钢板固定提供了一种可靠且有效的治疗策略，确保了坚强固定并促进了良好的功能和影像学结果。双柱钢板在治疗Schatzker V型和VI型骨折方面已被证明特别有效，由熟练的外科医生进行操作时可取得优异的效果。早期康复，包括使用持续被动运动（CPM），在将术后并发症如膝关节僵硬降至最低并促进最佳关节活动度方面起着至关重要的作用。
