ORIGINAL ARTICLE

Unstable Bicondylar Tibial Plateau Fractures:

A Clinical Investigation
Stefan Eggli, MD,* Maximilian J. Hartel, MD,* Sandro Kohl, MD,* Uli Haupt, MD,*
Aristomenis K. Exadaktylos, MD, and Christoph Roder, MD
Objective: To evaluate fracture patterns in bicondylar tibial plateau
fractures and their impact on treatment strategy.
Design: Prospective data analysis with documentation of initial
injury and treatment strategy, computed tomography scans, conven-
tional x-rays, long-term evaluation of radiographs, and functional
assessments.
Setting: Level 1 regional trauma center.
Patients: Prospective data acquisition of 14 consecutive patients
(10 male and 4 female) with a bicondylar tibial plateau fracture
(AO Type C).
Intervention: Application of a stepwise reconstruction strategy of
the tibial plateau starting with the reposition and xation of the
posteromedial split fragment using a 3.5 buttress plate, followed by
reposition and grafting of the lateral compartment and lateral xation
with a 3.5 plate in 90 degree to the medial xation device.
Main Outcome Measurements: All patients were evaluated with
full-length standing lm, standardized x-rays, Lysholm score for
functional assessment, and patients self-appraisal.
Results: Most of the complex bicondylar fractures follow a regular
pattern in that the medial compartment is split in a mediolateral
direction with a posteromedial main fragment, combined with various
amounts of multifragmental lateral compartment depression. The
technique introduced allows for accurate and stable reduction and
xation of this fracture type. The nal Lysholm knee score showed an
average of 83.5 points (range: 64.592).
Conclusions: Complex bicondylar tibial plateau fractures follow
a regular pattern, which is not represented in existing 2-dimensional
fracture classications. A 2-incision technique starting with the
reduction of the posteromedial edge results in accurate fracture
reduction with low complication rates and excellent knee function.
Key Words: tibial plateau fracture, osteosynthesis, orif, complica-
tions, trauma, outcome, fracture pattern, fracture reduction
(J Orthop Trauma 2008;22:673679)
INTRODUCTION
The treatment of bicondylar tibial plateau fractures
remains a highly demanding surgical procedure with
a signicant number of perioperative complications.
14
Whereas the lateral compression fracture is mainly produced
by low-energy force transmission in a valgus-exion
position,
58
bicondylar fractures result from a high load
induction to both compartments in a nearly neutral position.
Complex tibial plateau fractures are always accompanied by
serious soft tissue damage, which inuences the strategy of
treatment.
913
Intra-articular bleeding, combined with signif-
icant lesions of the musculo-ligamentous apparatus, causes
a rapid posttraumatic stiffness. To diminish this posttraumatic
functional loss of the knee joint, the time of immobilization
has to be held to a minimum. Therefore, the osseous
restoration of the plateau has to be accomplished early and
with sufcient biomechanical stability allowing immediate
passive motion training. In highly unstable bicondylar
fractures, sufcient xation with adequate reduction of the
fragments can be accomplished by direct reduction and
bilateral plating.
1416
The main problem with this strategy lies
in the additional soft tissue damage, with an increased rate of
skin necrosis and supercial or deep infections.
2,10,12,14
In this study, the authors analyzed the fracture pattern
and mechanism of bicondylar tibial fractures. From these
ndings, the surgical strategy for optimal fracture reduction
and biomechanical stabilization with minimal additional soft
tissue damage was developed. Finally, the clinical results and
the complications of this strategy are reported.
MATERIALS AND METHODS
Between 2003 and 2005, a total of 116 tibial plateau
fractures were treated at our institution. Of these, 35 were
classied as AO Type A, 67 as AOType B, and 14 consecutive
patients were found to have bicondylar tibial plateau fractures
(AO Type C). Only the C-type fractures were included in this
study. The sample included 10 male and 4 female patients with
an average age of 41 years (range: 2468 years). Accident
causes varied: 4 patients reported falling from a height; 3 were
involved in motor vehicle collisions; 3 were involved in
motorcycle accidents; 3 were injured during sporting activities
Accepted for publication August 20, 2008.
From the Departments of *Orthopaedic Surgery and Emergency, Inselspital,
and Institute for Evaluative Research in Orthopedic Surgery, University
of Bern, Bern, Switzerland.
The authors did not receive grants or outside funding in support of their
research or preparation of the manuscript.
The devices that are the subject of this article are approved by the US Food and
Drug Administration.
Reprints: Stefan Eggli, MD, Department of Orthopaedic Surgery, Inselspital,
University of Bern, CH-3000 Bern, Switzerland (e-mail: stefan.eggli@insel.ch).
Copyright 2008 by Lippincott Williams & Wilkins
J Orthop Trauma

Volume 22, Number 10, November/December 2008 673
(1 while bicycling and 1 while snow-skiing); and 1 was struck
by a motor vehicle while walking. Two fractures were open:
1 Type IIIA and 1 Type IIIB, according to Gustilo and
Anderson.
17
One patient showed partial neurologic decit of
the deep peroneal nerve, though none of the patients in the
sample had a vascular injury. All patients were treated by the
same 2 senior surgeons in accordance with a surgical protocol
established by our institution in 2003.
All patients had preoperative antero-posterior (AP) and
lateral view x-rays and computed tomography (CT) scans. CT
images were acquired using either a single-detector helical CT
(GE Hi-Speed, General Electric Medical Systems, Milwaukee,
WI) (n = 6 patients) or a 16-detector CT scan (GE Lightspeed,
General Electric Medical Systems) (n = 8 patients). Axial
source images of the knee joint were obtained, along with
reformatted coronal and sagittal images. Three-dimensional
reconstructions were calculated and viewed on a Sectra PACS-
workstation (Philips AG, Eindhoven, The Netherlands). CT
images were reviewed for fracture gap and articular depres-
sion. Postoperatively, both AP and lateral views were
performed. At nal follow-up, a full-length standing lm
was also done. Two unblinded, fellowship-trained orthopaedic
traumatologists assessed the quality of fracture reduction
on immediate postoperative and nal follow-up x-rays. The
5 radiographic parameters analyzed were articular reduction
(anatomic: #2 mm step per gap
14,18
), coronal alignment
[anatomic: medial proximal tibial angle (MPTA) 87 6 5
degrees
18,19
], sagittal alignment (anatomic: posterior proximal
tibial angle 9 6 4 degrees
20
), condylar width (anatomic:
#5 mm
18,21
), and frontal alignment (anatomic: 97 6 5
degrees
21,22
). Patients were clinically evaluated at 8, 12, and 24
weeks, and at 1 year; a nal follow-up was performed in 2006
at our institution with a functional assessment using the
Lysholm score.
22
Finally, patients were asked to rank the
outcome of the surgery into 1 of 4 categories: very good, good,
satisfying, and poor.
Technique
The patient was in the supine position, with the injured
leg placed on a mobile knee-exion wedge (Fig. 1). A
tourniquet was applied as far proximal as possible and after
exsanguination with an Eschmarch bandage inated to 350
mm Hg. The knee-exion wedge allowed for optimal
visualization and fracture reduction, which is best done in
extension for reducing the medial column, exion-external
rotation for plating the medial column, and extension-internal
rotation for xation of the lateral compartment. According to
the authors evaluation of the bicondylar fracture pattern,
which is discussed later in this article, the restoration of the
knee joint was always started at the medial side. Bio-
mechanically, the medial column forms the xed hinge of the
knee
23
and, according to its specic anatomic form, it almost
always shows a frontal mediolateral fracture course. Therefore,
in most cases, the main fragment is dislocated posterodistally.
Therefore, the rst incision is placed approximately 2 cm
posterior to the posteromedial edge of the tibial shaft, parallel
to the posterior border of the pes anserinus. The fascia of the
medial gastrocnemius is incised 0.5 cm posterior to the tibial
shaft longitudinally, and the pes anserinus is mobilized
anteriorly. The intra-articular fracture dislocation can be
visualized either with a small submeniscal incision or, better,
arthroscopically from an anteromedial portal. Arthroscopy is
mainly performed as a dry look with water only to wash out the
hematoma and to clean the optic. If there is a concomitant
meniscal tear, it should be sutured before fracture xation
because the medial compartment is wider and, technically, the
surgery can be performed without risk of redislocating the
fracture. After mobilizing the medial gastrocnemius from
the tibial periosteum, the distal dislocation of the posterior
wedge fragment can be identied by evaluating the incon-
gruency of the distal cortical fracture line. With a small
periosteal rasp, the impacted mediodorsal fragment is then
mobilized in exion and external rotation, which offers the
best view on the dorsal aspect of the tibia, and preliminarily
reduced. In this position, a 3.5-mm dynamic compression plate
(DC) plate is contoured and xed with only 1 screw approxi-
mately 2 cm distal to the distal margin of the split fragment.
The knee is then extended, and the posteromedial fragment is
reduced using the 3.5-mm plate as a dorsal buttress and is
nally xed with compression screws in a postero-anterior
direction (Fig. 2). Articular reduction can be controlled either
with a submeniscal mini-incision or arthroscopically. If reduc-
tion is hindered by the pes anserinus, a tenotomy is performed
2 cmproximal to the tibial insertion, which can be easily sutured
after successful reduction. Infrequently, the medial main
fragment is located at the anterior tibial border. In that case,
it can usually be reduced and xed percutaneously by using
compression screws in AP direction under arthroscopic control.
The lateral fracture is approached through a straight skin
incision from the lateral femoral condyle over the Gerdy
tubercle, 2 cm lateral to the tibial crest. The iliotibial band is
split longitudinally and mobilized distally from Gerdys
tubercle. With the knee exed in a varus and internally
rotated position, the intra-articular damage can be evaluated
through a submeniscal arthrotomy. The fracture is disimpacted
with a chisel and reduced directly; if the whole articular
surface is depressed as 1 block, an osteotomy approximately
3 cm below the joint line can be performed so that the
osteochondral plate can be reorientated as 1 block. The
FIGURE 1. Positioning of the patient during surgery with the
leg mobile on a knee-exion wedge.
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Volume 22, Number 10, November/December 2008
resulting subchondral or metaphyseal defect is then grafted
with autograft or bone substitute. Because lateral compression
fractures tend to broaden the compartment, a large compres-
sion clamp is applied and the mediolateral diameter of the tibia
is controlled under uoroscopy. Finally, a lateral compression
plate stabilizes the lateral compartment (Fig. 3). This allows
the mediolateral direction of the screws to be oriented in
a biomechanically favorable 90-degree angle to the postero-
anterior screw orientation of the medial compartment. In
addition, the lateral reduction is not compromised by screws
after xation of the medial compartment (Fig. 4).
Mobilization of the knee joint is started immediately
after surgery between 0 and 90 degrees. Weight bearing is
limited to 10 kg, and after 8 weeks, the rst clinical and
radiologic follow-up is performed. If the fracture is not
dislocated and the implants show no signs of loosening, weight
bearing is increased by 15 kg each week until full weight
bearing is achieved.
RESULTS
All 14 consecutively operated patients with an AO Type
C bicondylar fracture were included in this study. All had
complete follow-up data at 8, 12, and 24 weeks and 1 year after
surgery. Patients nal follow-up examination was conducted
at an average 25 months (range: 1638 months) posttrauma.
Five patients, including 1 open fracture (Type IIIA), were
operated within the rst 6 hours after injury. Six patients
underwent surgery within the rst 24 hours after their
accidents; the other 3 were operated between 1 and 7 days
posttrauma. Only 1 patient with a Type IIIB open fracture
received a temporary external xator after an initial debride-
ment and wound closure. All other fractures were treated in
1 stage.
A consistent fracture pattern was found wherein the
medial compartment showed the main fracture course in
a mediolateral direction with the main fragment located
posteriorly in 12 cases and anteriorly in 2 cases. In the lateral
compartment there was a posterior impression of the articular
surface in 4 cases, a central impression in 3 cases (intact lateral
tibial rim), an anterior impression in 2 cases, and a complete
one in 5 cases (anterior-posterior-central impression). In 4 of
14 cases the medial compartment was completely discon-
nected from the distal tibia, in 5 cases the lateral compartment
showed no intact communication to the distal tibia, and in 2
fractures both compartments were completely disconnected
FIGURE 2. The posteromedial split is indirectly reduced and
xed using a buttress plate with antiglide function in exion
and external rotation.
FIGURE 3. The lateral depression is reduced in exion and
internal rotation and xed with a compression plate.
FIGURE 4. Optimal biomechanical placement of the 2 plates in
90-degree orientation with a posteromedial buttress plate and
a lateral compression plate. The physiological valgus is
reconstructed.
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Volume 22, Number 10, November/December 2008 Bicondylar Tibia Plateau Fracture
from the distal tibia. Especially in the lateral compartment
the fracture often showed multiple fragments, which often
could be reduced only approximately. Based on the described
fracture patterns, a posteromedial buttress plate was used in
12 cases; in the 2 patients with an anterior split fragment, the
medial plateau was xed in one case with 2 transcutaneous lag
screws in antero-posterior direction and in the other patient
with an anteromedial buttress plate. In 8 cases, the visu-
alization of the medial compartment was reached by a poster-
omedial, submeniscal approach. In 6 cases, the reduction was
controlled arthroscopically. The lateral compression was
always reduced directly and xed with a 3.5-mm lateral
compression plate.
In 11 of 14 fractures morselized autologous cancellous
iliac crest graft was impacted to provide foundation for the
reduced osteocartilaginous joint fragment. There was 1 case
with a deep venous thrombosis 2 weeks after surgery and
1 partial neurologic decit of the deep peroneal nerve, both of
which resolved completely during the rst 4 postoperative
weeks. There was no case of infection in this series.
In 5 cases, direct inspection and arthroscopic evaluation
during surgery revealed a rupture of the ACL (anterior cruciate
ligament); of these, 4 were distal osseous avulsion fractures
and 1 was an intraligamentous tear. Two distal avulsion
fractures were repaired using transosseous sutures, 2 were
stable after fracture xation, while the intraligamentous tear
was xed with a combination of ligamentous sutures and
transosseous anchorage. In 6 knees, a total of 8 meniscus
lesions were found: 1 isolated medial meniscus tear, 3 isolated
lateral tears and 2 bilateral meniscus tears. Two menisci were
partially resected; all the others were sutured.
In the radiographic assessment, all fractures were healed
at 12 weeks. Twelve patients showed anatomic reduction with
less than a 2-mm step per gap. Two patients had a nonanatomic
gap or step between 2 and 5 mm. Twelve patients demonstrated
anatomic coronal alignment (MPTA 87 6 5 degrees). One
patient with nonanatomic coronal alignment had a varus
MPTA of 81 degrees and the other was in valgus with 93
degrees. This valgus malalignment developed secondarily
during the rst 8 weeks postoperatively, but remained stable
afterward. The posterior proximal tibial angle was measured as
anatomic in 13 cases (9 6 4 degrees) and in 1 patient it was
4 degrees. Finally, the condylar width was anatomic in all 14
patients. The Lysholm knee score showed an average of 83.5
points (range: 64.592). Patients assessment of surgery was
very good in 11 cases and good in 3.
DISCUSSION
Bicondylar tibial plateau fractures result from high-
energy injuries and are often combined with trauma to the
surrounding soft tissues.
9
The reconstruction of the knee joint
compartments demands extensive surgical approaches, leading
to even more soft tissue damage. Consequently, the
combination of traumatic and surgical soft tissue injury has
a high complication rate, especially regarding infections and
nonunions.
10,12,24,25
On the other hand, the knee is the
biomechanically most complex joint of the human locomotor
system. Therefore, severe injuries of the knee joint, and
especially bicondylar fractures of the tibial plateau, are often
highly complicated osseo-ligamentous lesions, which demand
a well-planned and precise preoperative surgical strategy to
restore the joint with minimal additional soft tissue injury.
In this study the authors present a series of 14 bicondylar
tibial fractures, of which 2 were open. Compared with other
studies, these injuries were caused by a rather low- to
moderate-energy trauma mechanism. Of course, high-energy
bumper injuries require a specic, staged soft tissue
treatment, which is not presented in this article. Also, during
the study period, only 3.5-mm DC plates were used. The
values of new xed-angle plates, which can obtain a theoret-
ically higher mechanical stability, especially in the lateral
compartment, are not presented. Nevertheless, the described
technique demonstrates that with conventional implants, good
reposition with high mechanical stability can be achieved.
Bhattacharyya et al
24
stressed the importance of
evaluating tibial plateau fractures on lateral views, criticizing
the fact that most fracture classications are based only on the
appearance of the fracture on AP views. Hackl et al
25
found
that 40% of the fractures classied with plain radiographs and
the AO system had to be changed after performing a CT scan.
Therefore, most authors now recommend a preoperative CT
scan to analyze a bicondylar tibial fracture.
14,21,26,27
In this
study, we found that most of the complex bicondylar fractures
follow a regular pattern in that the medial compartment is split
in a mediolateral direction, combined with various amounts of
multifragmental lateral compartment depression with broad-
ening of the lateral joint. Twelve of the 14 treated fractures
followed this fracture pattern. Both types of fractures, that is,
the lateral depression
10,24
and the posteromedial split,
28,29
are
described in the literature, but the consistent combination of
these 2 injuries in bicondylar tibial plateau fractures is not well
known. Consequently, neither the AO classication
30
nor the
Schatzker classication
31
describes this type of fracture. The
combination of the 2 fractures is explained by the anatomic
shape of the medial and lateral joint compartment. The medial
joint is convex to the tibial side and the femoral condyle glides
fairly constrained in the tibial cavity around a constant center
of exion. Axial load transmission from the femoral condyle
to the tibia leads to a blasting of the tibial tray similar to an
expulsion fracture seen in mechanical physics.
32
Due to the
negative anatomic slope of the tibial plateau, descending to the
posterior border, the resulting force vector mostly points
posteriorly, resulting in a posterior split fragment. Conversely,
the anatomic shape of the lateral compartment is convex to the
femur and the joint does not have a consistent rotation center
(Fig. 5). During exion, the rotation axis moves to the
posterior border of the tibia in a coupled exion-internal
rotation motion.
23
Axial load transmission leads to an
impression of the positively cambered surface similar to
a push-in of an eggshell. Thus, the more the knee is exed, the
more the femoral condyle glides posteriorly, resulting in
a more posteriorly located depression of the joint. Also, the
attening of the curved tibial compartment leads to an increase
of the coronal joint surface, resulting in a broadening of the
compartment. As stated above, existing fracture classications
are based on studies of 2-dimensional x-rays and therefore do
not correspond to the actual knowledge of fracture course
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Volume 22, Number 10, November/December 2008
based on CT data.
26,30,31
The authors ndings do not correlate
with an existing classication, and therefore, it is concluded
that there is need for a new classication of the tibial plateau
fractures based on latest knowledge from CT imaging and the
fracture patterns found in this study. Of course, a signicantly
larger series is needed to validate such a new classication
system.
The largely consistent fracture pattern found in this
series dened the surgical strategy for fracture reduction and
xation. Because the medial fracture consisted of only a single
main fragment with preserved anatomic landmarks in the
majority of cases, fracture reduction begins medially. Restor-
ing the mechanical stability of the medial hinge is the key step
in correcting the anatomic angles, especially in the frontal
plane. Georgiadis
27
rst reported on 4 cases treated with
a posteromedial buttress plate, emphasizing the increased
biomechanical stabilization achieved with this technique.
Carlson
28
used the same approach but did not divide the
medial head of the gastrocnemius, as described by De Boeck
and Opdecam.
29
The authors used a posteromedial approach
2 cm behind the posterior border of the tibia. The medial head
of the gastrocnemius was mobilized from the tibia, which
allowed for direct reduction and buttress plating.
33,34
A
tenotomy of the pes anserinus was performed when reduction
of the posteromedial fragment was hindered. Repositioning of
the posteromedial edge is performed under direct control in an
extended leg position. Stabilization of the fracture is then
performed using a posteromedial buttress plate, which
neutralizes the posteriorly directed femorotibial force vector.
Application of the plate is best done in a exed and externally
rotated position of the knee. The sagittal direction of the
screws allows for unhindered reduction and xation of the
lateral compartment, which is not the case if the medial
fragment is xed with a medial compression plate or if the
lateral side is reduced rst. In this series, anatomic reduction
with no secondary dislocation of the medial compartment
could be accomplished in all cases.
Reduction and xation of the lateral compartment was
performed through the well-described submeniscal antero-
lateral approach.
14,27,35
The repositioning must be controlled
by intraoperative uoroscopy. In this way, the height of the
articular repositioning determines the frontal alignment of the
leg axis and is validated with the easy-to-use cable
technique described by Krettek et al.
36
Finally, the attening
of the lateral compartment is mostly combined with
broadening of the joint line. This can be accurately analyzed
using intraoperative uoroscopy and corrected with a large
compression C-clamp. Using these techniques of open
reduction and internal xation, the authors achieved a highly
accurate repositioning of these complex fractures in 12 of 14
injuries, and the remaining 2 had a step or gap of only 25 mm
(Fig. 6). Also, coronal alignment (12 of 14 cases anatomi-
cally), posterior proximal angle (13 of 14 cases anatomically),
and condylar width (14 of 14 cases anatomically) could be
corrected to a highly satisfactory extent.
Colletti et al
37
noted in a magnetic resonance imaging
study that tibial plateau fractures are commonly associated
with ligamentous and meniscal injuries. Barei et al
14
found
38.6% meniscal injuries in a series of 83 bicondylar fractures
but did not report about ligamentous injuries; Chan et al
38
described a high association of ACL tears with a posteromedial
avulsion fragment. In this series, concomitant menisco-
ligamentous injuries were found in more than 50% of the
fractures. Five patients showed a torn ACL but only 1 tear was
intraligamentous. Osseous rexation was performed arthro-
scopically in only 2 cases, when after fracture xation, the
osseous avulsion of the ligament remained unstable. In 2 cases,
the ACL was already stably xed after reconstruction of the
tibial head. Similar to Colletti et al,
37
meniscal injuries were
more frequently found laterally. Using a submeniscal ap-
proach, these tears could be sutured directly and reattached to
the capsule. Medial meniscal tears were sutured arthroscopi-
cally before fracture xation to avoid a secondary dislocation
of the lateral compartment while applying valgus stress.
There is a high rate of postoperative complications
reported in the literature after open reduction and internal
xation of bicondylar tibial plateau fractures, mainly due to
severe concomitant soft tissue injury.
14,39
Because of the high
incidence of deep infection, Young and Barrack
2
recommen-
ded treating these fractures conservatively, while Mallik et al,
1
reporting an infection rate of 80% after open reduction and
internal xation (ORIF) of tibial plateau fractures, suggested
stabilization of the proximal tibia with external xation
devices. The high infection rates after open surgery reported in
the literature are mainly based on the data of a midline incision
FIGURE 5. Medial compartment is convex to the tibial side (A);
axial load transmission leads to split fractures in mediolateral
direction (B). The lateral compartment is convex to the femoral
side (C); axial load transmission leads to multifragmetary
depression with broadening of the lateral joint (D).
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Volume 22, Number 10, November/December 2008 Bicondylar Tibia Plateau Fracture
approach with dual bilateral condylar plating, which requires
complete detachment of the anterior soft tissue layer.
2,26,31
With the introduction of the bilateral approach, that is, antero-
lateral and posteromedial incisions, combined with immediate
surgical intervention, infection rates decreased signi-
cantly.
14,27,35
Nevertheless, a staged protocol, using an external
xator, is recommended, if the general condition of the patient,
presence of associated injuries, or critical local soft tissue
conditions do not allow for immediate reconstruction.
12,14,33
In this series there was no infection after ORIF because
the bilateral approach leaves a large vital skin bridge between
the 2 incisions.
14
In our opinion, this approach is safe if
performed as described and allows for a combined direct-
indirect reduction of the main articular fragments, either
controlled with a direct submensical approach or arthroscopi-
cally. The advantage of direct open repositioning, especially in
the medial compartment, lies in the near-anatomic reposition
of the main fragments.
34,40
Thus, 85% of the patients showed
an anatomic reduction of the joint surface in this series; the
remaining 15% had a step or gap deformity of 5 mm or less at
nal follow-up. These data are in accordance with Barei et al
14
who reported a reduction of the fracture within a 5-mm
accuracy in 95% of the patients, using the same approaches.
Bhattacharyya et al
24
observed a signicant correlation
between functional outcome and accuracy of articular reduc-
tion. The authors found that the medial plateau, which takes
almost 70% of the mechanical load,
41
is mostly fractured into
only 24 pieces and therefore should ideally be reduced
absolutely anatomically. The lateral compartment, due to the
mechanism described earlier in this article, is often commi-
nuted into multiple pieces and in many cases can only be
reduced approximately. Nevertheless, if the axis is not
malaligned into an excessively valgus position, the accurate
reduction of the medial side results in a good clinical result.
Papagelopoulos et al
39
stressed the importance of early motion
to avoid intra-articular adhesions. The bilateral plating in a
90-degree direction provided enough mechanical stability to
allow for immediate motion and partial weight bearing. There
was only 1 case that demonstrated a slight secondary shift
of position of the stabilized tibial plateau during the healing
process. Thus, as a result of the described treatment strategy,
patients achieved a highly satisfactory knee function with an
average Lysholm score of 83.5 points at nal follow-up.
Accordingly, 11 patients rated the outcome of treatment as
very good and 3 patients labeled their outcomes as good.
The authors conclude that bilateral condylar tibial
fractures follow a regular pattern, which is explained by the
anatomic form and motion of the 2 tibio-femoral compart-
ments. Existing classications, based on 2-dimensional x-rays
do not describe these fracture types correctly, and therefore,
a new classication based on CT data is needed. The 2-
incision approach allows for accurate reduction and optimal
biomechanical stabilization of the fracture, starting with the
reconstruction of the posteromedial edge. The procedure,
combined with immediate motion and partial weight bearing,
showed a low complication rate and high accuracy of joint
reconstruction, resulting in excellent knee function and high
patient satisfaction.
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J Orthop Trauma

Volume 22, Number 10, November/December 2008 Bicondylar Tibia Plateau Fracture