Comparison of anterior midline incision and double incision in the surgical treatment of tibial plateau fractures

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Aim: Tibial plateau fractures are complex fractures that often develop after high-energy trauma, often involving intra-articular fractures. They are rarely treated conservatively. Surgical planning and approach are very important in preventing possible complications. In this study, we compared two different incisions in the same fracture types.
 Material and Method: A total of 26 patients (20 males-6 females) with tibial plateau fractures were included in the study. Twelve of the patients were selected from those using anterior midline incisions, and 14 from those using double incisions as anterolateral and posteromedial incisions. The mean age of the patients is 50.8 (24-76) years. The distribution of patients according to fracture classification was 9 Schatzker type-6, 17 Schatzker type-5. Average follow-up time is 34.1 months (24.5-42.2). Postoperative complications, union time, joint range of motion, radiological Rasmussen criteria, Medial Proximal Tibial Angle (MPTA) and Posterior Proximal Tibial Angle (PPTA) measurements, Lachman and valgus-varus stress tests for ligament stability evaluation, Hospital for Special Surgery (HSS) and visual analogue scale (VAS) assessments were performed to evaluate the clinical status of the patients. Results were compared between both incision groups.
 Results: Union in the anterior midline was 11.07 (±1.68) weeks and bilateral union was 9.96 (±1.35) weeks (p :0.074). Rasmussen scoring was 14.83 (±2.16) in the anterior group and 14.57 (±2.13) in the bilateral group (p:0.760). The MPTA was 85.35 (±3.97) degrees in the anterior group, and the MPTA was 86.40 (±3.74) degrees in the bilateral group (p: 0.492). PPTA was 80.77 (±1.95) degree in the anterior group, and PPTA was 80.85 (±1.78) degree in the bilateral group. HSS score was 70 (±9.02) in the anterior group and HSS score was 71.71 (±1.15) in the bilateral group (p:0.681). Rom was measured as 101.67 (±12.67) degrees in the anterior group and 107.86 (±13.54) degrees in the bilateral group (p: 0.243). The VAS anterior group was 2.83 (±1.64) and the VAS bilateral group was 3.36 (±2.09) (p:0.491).Instability was seen in 1 patient in the anterior group and 1 patient in the bilateral group (p:1). Infection was observed in 1 patient in the anterior group and in 3 patients in the bilateral group (p:0.598). 
 Conclusion: The anterior incision is as effective a surgical approach as bilateral incision in correct patient preferences. Surgical site visibility in anterior incision is satisfactory. The principal aspect is to perform the correct surgical planning for the correct patient.