Review Question - QID 4382

The above clinical scenario is consistent with a bicondylar tibial plateau fracture. Bicondylar tibial plateau fractures are best definitively treated with dual incision technique using separate lateral plateau and posteromedial plates.

Yoo et al perfored a biomechanical study comparing locking and nonlocking single and dual plating constructs in maintaining posteromedial fragment reduction in a bicondylar tibial plateau fractures. They found that the posteromedial fracture fragment tolerated higher loads with a posteromedial conventional plate construct. The superiority of this dual plating construct may be caused by unreliable penetration of the posteromedial fragment by the lateral locking screws alone.

Zeng et al also performed a biomechanical study comparing the biomechanical strength of four different fixation methods for the posteromedial tibial plateau split fracture. The four following constructs: anteroposterior lag-screws, an anteromedial limited contact dynamic compression plate (LC-DCP), a lateral locking plate, or a posterior T-shaped buttress plate were studied. They found that the posterior-based buttress plating technique was the most biomechanically stable fixation method allowing the least amount of fracture subsidence for posteromedial split tibial plateau fractures.

Figure A shows an AP radiograph of a bicondylar tibial plateau. Illustration A shows a post-operative radiograph following the dual-plating technique for bicondylar tibial plateau fractures.

Incorrect answers:
Answer 1: External fixation is not the most appropriate definitive care for bicondylar tibial plateau fractures.
Answers 2-4: Not as biomechanically stable as dual plating technique for bicondylar tibial plateau fractures.