Functional outcomes of posteromedial plating in proximal tibial plateau fractures: a prospective clinical study

Background: Proximal tibial plateau fractures involving the posteromedial fragment represent a complex injury pattern associated with instability, late collapse, and poor functional outcomes if inadequately addressed. Conventional fixation strategies focusing only on the anterolateral column may fail to counteract posterior shear forces acting on the medial tibial plateau. Methods: This prospective clinical study included 30 patients with proximal tibial plateau fractures involving the posteromedial fragment treated with posteromedial buttress plating, with or without additional lateral fixation, at a tertiary care center. Fractures were classified using the Schatzker system. Functional outcomes were assessed using the Rasmussen functional scoring system at final follow-up. Radiological outcomes and post-operative complications were also evaluated. Results: The mean age of the 30 patients was 42.0±8.92 years, and 25 (83.33%) were male. Motor vehicle accidents were the most common mechanism of injury (13 (43.33%)). Schatzker type IV, V, and VI fractures were observed in 18 (60.00%), 9 (30.00%), and 3 (10.00%) patients, respectively. Single posteromedial plating was performed in 21 (70.00%) patients and double plating in 9 (30.00%). Rasmussen functional outcomes were excellent in 21 (70.00%), good in 6 (20.00%), and fair in 3 (10.00%) patients, with no poor outcomes. Knee stiffness occurred in 2 (6.67%) patients and wound dehiscence in 1 (3.33%); no hardware failure was reported. Conclusion: Posteromedial plating provides biomechanically stable fixation for proximal tibial plateau fractures involving the posteromedial fragment, resulting in favourable functional outcomes and a low complication rate. Direct fixation of the posteromedial fragment should be considered an integral component in the management of complex proximal tibial plateau fractures.