Early Six-Month Functional and Radiological Outcomes of Expert Tibia Nailing in Intra-articular Tibial Plateau Fractures: A Prospective Study

Background and objective Intra-articular tibial plateau fractures present significant management challenges. Traditional plating can compromise soft tissues, whereas Expert Tibia Nailing provides minimally invasive fixation with multidirectional locking capabilities. This study aimed to evaluate the early functional and radiological outcomes of Expert Tibia Nailing, with an a priori comparison between simple (Schatzker I-IV) and complex (V-VI) tibial plateau fractures. Methods This prospective observational study included 36 patients treated with Expert Tibia Nailing at the Department of Orthopaedics, Netaji Subhash Chandra Bose Medical College, Jabalpur, from May 2022 to June 2024. The cohort comprised 29 males (80.6%) and seven females (19.4%), with a mean age of 41.6 ± 11.5 years. The primary outcome was the Knee Society Score (KSS) at six months. Secondary outcomes included time to weight-bearing, radiological union, and complications. Categorical variables were analyzed using the chi-square test or Fisher’s exact test, and continuous variables were analyzed using the Mann-Whitney U test. Results Road traffic accidents accounted for injuries in 27/36 patients (75.0%), while falls accounted for 9/36 cases (25.0%). Schatzker type II, type IV, and type V fractures were each observed in 7/36 patients (19.4%). The mean time to partial weight-bearing was 8.11 ± 1.8 weeks, and the mean time to radiological union was 15.83 ± 2.9 weeks. At six months, KSS outcomes were rated as excellent in 10/36 patients (27.8%), good in 16/36 (44.4%), fair in 4/36 (11.1%), and poor in 6/36 (16.7%). Excellent-to-good outcomes were achieved in 26/36 patients (72.2%). Patients with Schatzker types I-IV demonstrated significantly better outcomes than those with types V-VI (20/23, 87.0% vs. 6/13, 46.2%; p = 0.007). Complications occurred in 14/36 patients (38.9%), including knee stiffness in 7/36 (19.4%), condylar collapse in 6/36 (16.7%), superficial infection in 3/36 (8.3%), and malunion in 1/36 (2.8%). No cases of nonunion, deep infection, compartment syndrome, implant failure, or neurovascular injury were observed. Conclusions Expert Tibia Nailing yielded satisfactory early functional and radiological outcomes in this prospective series of tibial plateau fractures, with low rates of deep infection, nonunion, and neurovascular complications. However, the technique demonstrated poorer results and a higher complication burden in bicondylar fractures; therefore, its use should be limited to carefully selected unicondylar patterns. Larger multicenter studies with longer follow-up periods are needed to confirm its role relative to plate-based fixation.