Dual-Plate Fixation of a Complex Proximal Tibial Plateau Fracture

The patient presented with a complex proximal tibial plateau fracture characterized by intra-articular extension and a large displaced posteromedial fragment. Preoperative planning identified the posteromedial fragment as the principal component requiring direct reduction and buttress fixation. Surgery was delayed for approximately 10 days to allow recovery of the soft-tissue envelope. A dual-plating strategy was planned, beginning with posteromedial stabilization followed by lateral fixation. The operative approach and implant positions were determined by the three-dimensional fracture configuration.

1. The posteromedial fragment was exposed and reduced first
2. A medial plate was positioned and provisionally secured
3. An anterolateral incision was then made between Gerdy’s tubercle
4. A 4.5-mm plate was initially considered but was replaced
5. Knee mobilization was planned from postoperative days 2–3