Clinical outcomes of 20 schatzker type II tibial plateau fractures after open reduction, internal fixation and bone grafting

Background: Tibial plateau fractures, particularly Schatzker type II, pose significant challenges due to their intra-articular nature and potential for long-term disability if not properly managed. Achieving anatomical reduction, restoring joint stability, and preventing articular collapse are critical. Open reduction and internal fixation (ORIF) with autologous bone grafting has been advocated to address these goals. Aim: This study aims to evaluate the effectiveness of open reduction and internal fixation (ORIF) using locking compression plates (LCP) combined with autologous iliac crest bone grafting in Schatzker type II tibial plateau fractures, thereby contributing to the optimization of treatment strategies. Materials and Methods: In this prospective study 20 patients with Schatzker type II tibial plateau fractures were included. After initial emergency management and radiological evaluation including 3D CT reconstruction, patients with ≥3 mm articular depression and ≥5 mm condylar widening were selected for surgical intervention. All patients underwent ORIF with LCP and iliac crest bone grafting. Postoperative rehabilitation included early range of motion and staged weight-bearing. Patients were followed up at regular intervals and final functional outcome was assessed at 6 months using the Rasmussen grading system. Results: The average time to initiate partial weight-bearing was 10.16 weeks (range: 8-12 weeks), and full weight-bearing was achieved at a mean of 15.4 weeks (range: 13-17 weeks). The Rasmussen score ranged from 19 to 30, with a mean of 27.5. Sixteen patients had excellent outcomes, three had good outcomes, and one patient had a fair result. There were no poor outcomes. All fractures united, and 80% of patients returned to their pre-injury level of activity. Conclusion: ORIF with locking plate fixation and autologous bone grafting offers excellent functional and radiological outcomes in Schatzker type II tibial plateau fractures when guided by appropriate surgical indications. This approach facilitates early mobilization, reduces the risk of complications such as joint incongruity and collapse, and promotes return to pre-injury function.