Long-term outcomes of dual locking-plate fixation for bicondylar tibial plateau fractures via two mini-incisions: A prospective study.

Background: Bicondylar tibial plateau fractures are complex injuries that frequently involve a posteromedial fragment and carry a high risk of post-traumatic osteoarthritis. However, long-term outcome data on dual locking-plate fixation are limited, particularly in Southeast Asian populations. Objective: The aim of this prospective study was to evaluate longitudinal clinical and imaging outcomes of bicondylar tibial plateau fractures managed with anterolateral and posteromedial locking plates via two mini-incisions. Methods: This prospective study included 55 patients treated with open reduction and dual locking-plate fixation via anterolateral and posteromedial mini-incisions. Outcomes included radiographic parameters, clinical function and complications. Results: The mean age was 45.4 ± 12.4 years; 60% of patients were male and motorcycle accidents accounted for 90.9% of injuries. Forty-five patients (81.8%) completed the 60-month assessment. Lateral plateau depression was reduced from 5.25 mm preoperatively to 1.00 mm postoperatively and was 2.17 mm at 5 years. KSS Knee peaked at 12 months (83.4 ± 8.2) and was 78.9 ± 8.8 at 5 years; the Rasmussen clinical score followed a similar trajectory. The overall complication rate was 23.6%, with a single deep infection (1.8%). Kellgren-Lawrence grade ≥ 2 increased from 14.5% of injured knees at 12 months to 53.3% at 60 months. Schatzker VI was associated with smaller Rasmussen clinical improvement than Schatzker V (-2.09; p = 0.023). Conclusions: Dual locking-plate fixation through two mini-incisions provides favorable clinical and functional outcomes up to 5 years for bicondylar tibial plateau fractures; however, progressive post-traumatic osteoarthritis remains a long-term concern warranting surveillance.