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Medial and lateral plate fixation through two approaches
85%
901/1060
Medial and lateral plate fixation through a single anterior approach
2%
18/1060
Lateral locking plate fixation
1%
13/1060
Continued external fixation until union
3%
36/1060
Multiplanar transarticular external fixator
8%
90/1060
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The Figure shows a bicondylar tibial plateau fracture. The goals that need to be met when treating tibial plateau fractures are the following: restoration of mechanical axis alignment, restoration of condylar width, articular reduction, and restoration of knee stability. Since the soft tissue envelope is favorable, open reduction internal fixation with dual incisions and dual plates will provide the best probablity of achieving those goals. Gosling et al did a biomechanical evaluation in cadavers comparing lateral locked plating with a combined medial and lateral plate and found no difference in resistance to vertical subsidence even with loads exceeding the average body weight. However, this was a cadaveric study with no mention and capability of analyzing articular reduction. Lateral locked plating only allows for indirect reduction of the medial plateau. Barei et al in a retrospective review found that comminuted bicondylar tibial plateau fractures can be successfully treated with open reduction and medial and lateral plate fixation using 2 incisions, and postulate that the use of 2 incisions may contribute to a lower wound complication rate. A two incision approach allows not necessarily for a stronger construct as some studies are controversial, but for a more accurate reduction and restoration of alignment.
3.1
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