• Stefan Eggli, Maximilian J Hartel, Sandro Kohl, Uli Haupt, Aristomenis K Exadaktylos, and Christoph Röder.
• Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland. stefan.eggli@insel.ch
• J Orthop Trauma. 2008 Nov 1; 22 (10): 673-9.

ObjectiveTo evaluate fracture patterns in bicondylar tibial plateau fractures and their impact on treatment strategy.DesignProspective data analysis with documentation of initial injury and treatment strategy, computed tomography scans, conventional x-rays, long-term evaluation of radiographs, and functional assessments.SettingLevel 1 regional trauma center.PatientsProspective data acquisition of 14 consecutive patients (10 male and 4 female) with a bicondylar tibial plateau fracture (AO Type C).InterventionApplication of a stepwise reconstruction strategy of the tibial plateau starting with the reposition and fixation of the posteromedial split fragment using a 3.5 buttress plate, followed by reposition and grafting of the lateral compartment and lateral fixation with a 3.5 plate in 90 degree to the medial fixation device.Main Outcome MeasurementsAll patients were evaluated with full-length standing film, standardized x-rays, Lysholm score for functional assessment, and patient's self-appraisal.ResultsMost 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 fixation of this fracture type. The final Lysholm knee score showed an average of 83.5 points (range: 64.5-92).ConclusionsComplex bicondylar tibial plateau fractures follow a regular pattern, which is not represented in existing 2-dimensional fracture classifications. 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.

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