Bicondylar tibial plateau fracture treated by open reduction and fixation with unilateral locked plating

The management of bicondylar tibial plateau fractures is challenging. A lateral locking plate offers an alternative method to traditional dual plating to avoid further stripping of soft tissue. Nevertheless, the rate of malreduction and fixation loss remains high. From 2007 to 2009, we performed open reduction and fixation with unilateral locked plating to directly reduce the fracture in 15 patients with bicondylar plateau fracture. The average follow-up duration was 16.2 months (range: 12-30 months), and the average age of the patients was 43 years (range: 19-64 years). All fractures were Orthopaedic Trauma Association type 41-C. Postoperative radiographic alignment was evaluated immediately and at 2-4 weeks, 8-12 weeks, 5-7 months, and 11-13 months. Both Oxford knee score and Hospital for Special Surgery knee score were used to evaluate functional outcomes. The average duration within which union was achieved was 4.8 months (range: 2-10 months). One patient incurred wound dehiscence; however, there was no case of deep infection. Malreduction occurred in one patient (6.7%) while fixation loss occurred in three patients (20%) with subsidence of the posteromedial fragment and varus malalignment. Despite the malreduction rate being lower in our study than in previous studies involving unilateral locked plating, a high rate of fixation loss was recorded. Per our limited experience, we believe that unilateral locked plating may have limitations in patients with selective patterns of bicondylar tibial plateau fractures.