Review Question - QID 4791

Treatment of a comminuted bicondylar tibial plateau fracture such as the one shown in Figures A and B is best treated with dual plates (or more), as the posteromedial fragment(s) is usually a large section of the medial plateau and is poorly stabilized from a single lateral plate.

Barei et al (2008) retrospectively reviewed 57 patients with bicondylar tibial plateau fractures, evaluating the frequency and morphologic characteristics of the posteromedial fragment in this injury pattern. They found that 74% of these injuries had a posteromedial fragment that may require alternate or supplementary fixation methods when managing this injury pattern.

Barei et al (2006) reviewed 83 bicondylar tibial plateau fractures that were treated with medial and lateral plate fixation through two exposures. They noted that residual dysfunction is common. Accurate articular reduction was possible in about 55% of the patients and the reduction was associated with better outcomes within the confines of the injury severity.

Figure A and B show a comminuted bicondylar tibial plateau fracture. Figure C is an axial CT cut showing the medial fragments (anterior and posterior).

Incorrect Answers:
Answer 1: Definitive use of the spanning external fixator would lead to significant knee stiffness.
Answer 2: Conversion to a hinged knee fixator is not commonly recommended for this injury pattern.
Answer 3: This comminuted tibial plateau fracture is not amenable to treatment with an intramedullary nail.
Answer 4: Use of more than one plate to instrument this fracture is necessary.