In tibial plateau fractures, Schatzker type VI (bicondylar fracture with metaphyseal-diaphyseal dissociation) is optimally managed by:
- A Single medial plate via a posteromedial approach
- B Intramedullary nail alone
- C Non-operative management with early mobilisation
- D Dual-plating (medial and lateral columns independently fixed) with attention to soft tissue management using staged fixation (temporary external fixator followed by definitive plating at 7–14 days) ✓
Explanation
Schatzker VI fractures have both condyles disrupted with a fracture line extending into the diaphysis, rendering the entire proximal tibia unstable. Dual-column plating (medial posteromedial plate + lateral locking plate) is the standard because each column requires independent fixation. However, due to the severe soft tissue injury (degloving, crush) associated with high-energy bicondylar fractures, immediate definitive plating risks wound dehiscence and deep infection. The 'staged protocol' — temporary external fixation spanning the knee (ligamentotaxis) followed by definitive dual plating when soft tissue swelling resolves (wrinkle sign, 7–14 days) — dramatically reduces wound complications and is the current standard of care.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.