Vol. 11, Issue 4 (2025)

Background: Tibial plateau fractures (TPF) are critical due to their occurrence in a major weight-bearing joint, often resulting in significant functional impairment and complications. As one of the most common types of intra-articular injuries, these fractures present unique challenges in management. The objective of this study was to assess and compare the functional outcomes of internal fixation (IF) versus external fixation (EF) for the management of bicondylar TPF, with management approaches determined based on specific patient selection criteria. 
Methods: A total of 60 cases with tibial condyle fractures (Schatzker type V and VI) were enrolled. Among these, 38 cases (with closed fractures or Type I and II open fractures with good skin conditions) underwent open reduction and IF (ORIF) using dual buttress plates, buttress plates, and CC screws. The remaining 22 cases (with closed fractures, Type I and II open fractures with poor skin conditions, or impending compartment syndrome (ICS)) were treated with hybrid EF. All cases were followed up at six weeks, six months, and twelve months to evaluate their functional outcomes using the Hospital for Special Surgery Knee-rating Score (HSSNRS) system. 
Result: In our study, >85% of cases achieved good to excellent results according to the HSSNRS. At the 1-year follow-up, there was no significant difference in the functional outcomes between the two fixation methods. The average HSS score at the final follow-up was 78.87±10.94 for the IF group and 78.71±9.05 for the EF group. 
Conclusion: Both IF and EF for bicondylar TPF can result in favorable functional outcomes, provided that the selection criteria are strictly adhered to. Careful case selection based on fracture type, soft tissue (ST) condition, and other factors is crucial to ensuring optimal results and minimizing complications. When applied appropriately, both methods offer effective solutions for restoring joint stability and function.