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Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 67-72

Early intervention within 24 h using anterior midline single incision with dual plating for bicondylar tibial plateau fractures schatzker type v and vi: An analytical study

Department of Orthopaedics and Traumatology, Preethi Institute of Medical Sciences and Research, Preethi Hospitals Pvt. Ltd., Madurai, Tamil Nadu, India

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joasis.joasis_28_21

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Introduction: Schatzker Type V and VI fractures are high-velocity injury; they are bicondylar fractures of proximal tibia with significant articular involvement multiple displaced condylar fracture lines, metaphysiodiaphyseal extension with comminution with high incidence of compartment syndrome and soft tissue injury. Span, scan and plan, and later open reduction and internal fixation with dual incision dual plating is gold standard; Midline incision is considered as history and associated with complications. Purpose: The purpose of the study is to evaluate functional outcome in Type V and VI Schatzker bicondylar tibial plateau fractures, with early intervention using anterior midline approach and Dual plating. Materials and Methods: We analyzed retrospectively 35 patients from 2015 to 2018 at our tertiary center. All patients were operated within 12–24 h of injury using anterior midline approach and dual plating. Patients were evaluated radiologically (coronal alignment using medial proximal tibial angle, sagittal alignment using posterior proximal tibial angle and condylar width) functional and clinical assessment was done using Rasmussen and visual analog scale scoring at regular intervals till the last follow-up. Results: Bony union was achieved at average of 14 weeks (12–20 weeks), 80% patient had excellent and good results. 22% of patient needed bone grafting which was done primarily and 11.1% patient required an additional split skin graft and flap surgery. Complications such as deep and superficial infection were seen in 8.5%, knee stiffness (range of motion <90°) in 8.5%, and varus/valgus malalignment in 14.4% was seen. None of our patients had deep vein thrombosis (DVT). Average of hospital stay was 5.6 days only. Conclusion: Early intervention with single-incision anterior midline approach with dual plating for complex Type V and VI Schatzker bicondylar tibial plateau fractures can still be considered as a method of treatment when intervened early. The excellent functional outcome in this study, lower rate of complications, less incidence of DVT and shorter hospital stay are well comparable to dual incision technique.

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