Short Term Radiological and Clinical Outcomes of Fixation of Schatzker II Tibial Plateau Fractures by Screws Only Versus Plate and Screws,   A Comparative Study

Abstract Background Trauma with high or low energy can cause complicated injuries like tibial plateau fractures. In this study, we aimed to compare the radiographic and clinical results of two treatment modalities for tibial plateau fractures: closed reduction with percutaneous cannulated screws fixation alone and open reduction with plate and screws. The fractures were classified as type II according to Schatzker. Methods This prospective randomized controlled clinical trial research was performed on 40 individuals aged from 18 to 70 years old, both sexes, skeletally mature patients with Schatzker type II (closed split depression of the lateral tibial plateau). From September 2023 till January 2025. Patients were classified into two groups: Group A (fixation by screws only) and Group B (fixation by plate and screws). Results Group A has a shorter mean operative time (85.80 ± 3.47 minutes) compared to Group B (104.35 ± 2.92 minutes, p < 0.001). Follow up postoperative X-ray there was no significant variation between groups (p = 0.722), with both groups showing excellent initial radiographic outcomes. While the follow up 2nd X-ray and 3rd X-ray: Group B showed significantly better radiological scores and a higher proportion of excellent outcomes compared to Group A (p < 0.001 for both follow-ups). No significant difference in MPTA values in the 1st X-ray (p = 0.159). Group A showed higher MPTA values in the 2nd and 3rd X-rays, indicating more alignment changes in contrast to Group B (p < 0.001). Group B achieved significantly higher clinical scores (28.20 ± 1.06) in contrast to Group A (23.80 ± 2.73, p < 0.001), with 75% of patients in Group B having excellent outcomes versus only 15% in Group A. Group B demonstrated shorter times to union (mean: 13.45 ± 0.51 weeks) and rehabilitation (mean: 9.60 ± 2.11 weeks) compared to Group A (16.85 ± 0.88 weeks and 12.65 ± 2.96 weeks, respectively, p < 0.001). In terms of overall complications, there was no statistically significant distinction (p = 0.109) between the groups. Group B has fewer cases of nonunion and malunion compared to Group A, suggesting better healing stability. Conclusions Fixation using plates and screws (Group B) provides superior clinical and radiological outcomes compared to fixation using screws alone (Group A) in Schatzker II tibial plateau fractures. These results suggest that adding a plate to screw fixation may offer enhanced stability, improved healing, and better long-term outcomes. Type of study/level of evidence Therapeutic IV. Trial registration number: NCT06353048 Date of registration: 17 March 2024. The protocol and statistical analysis plan are available from the corresponding author upon reasonable request. Study plan is available at https://clinicaltrials.gov/study/NCT06353048