DOI: https://doi.org/10.36347/sjams.2026.v14i03.014

Pages: 401-406

Background: Comminuted proximal tibial fractures present a significant surgical challenge due to the complex anatomy of the tibial plateau and the need to restore joint congruity, alignment, and stability. Although single lateral plating is commonly used, dual plating has been advocated for complex bicondylar fractures to enhance stability and maintain reduction. However, controversy persists regarding the superiority of one technique over the other. Objective: To compare single plating (SP) and dual plating (DP) techniques in the management of comminuted proximal tibial fractures with respect to fracture healing, functional outcomes, radiological alignment, and postoperative complications. Methods: This randomized controlled trial was conducted at a tertiary care hospital in Satkhira, Bangladesh, from June 2024 to June 2025. Sixty skeletally mature patients with unstable bicondylar proximal tibial fractures (Schatzker type V and VI) were randomized into SP and DP groups. After exclusions, 26 patients remained in the SP group and 30 in the DP group. Functional outcomes were assessed using Rasmussen’s Functional Score, Rasmussen’s Radiological Score, Oxford Knee Score, and knee range of motion. Radiological alignment was evaluated using medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA). Patients were followed for a minimum of 12 months. Results: Baseline demographic and fracture characteristics were comparable between groups. Early weight-bearing (≤20 weeks) and fracture union (≤19 weeks) were slightly higher in the DP group (55% and 61%) compared to the SP group (52% and 58%), though differences were not statistically significant. Functional outcomes, including range of motion ≥120°, Oxford Knee Score ≥42, and Rasmussen’s functional score ≥25, were comparable between groups. However, radiological outcomes significantly favored DP, with higher rates of normal MPTA (72% vs 58%, p = 0.04), normal PPTA (82% vs 65%, p = 0.0005), and Rasmussen