DOI: https://doi.org/10.36347/sasjs.2026.v12i08.010

Pages: 694-701

Introduction: Schatzker VI tibial plateau fractures combine complex articular disruption with metaphyseal-diaphyseal dissociation. Management becomes particularly demanding when severe soft-tissue injury is present, especially fracture blisters. Case presentation: A 42-year-old man was admitted four hours after a motorcycle-car collision for a closed left lower-limb injury. The knee was swollen, in varus, with extensive medial ecchymosis, while the neurovascular examination was normal. Fracture blisters developed within six hours. Plain radiographs and computed tomography confirmed a bicondylar tibial plateau fracture with metaphyseal-diaphyseal dissociation and diaphyseal extension, classified as Schatzker VI. After immobilisation, analgesia and thromboprophylaxis, the blisters were punctured on day 1 and treated locally with eosin. On day 2, definitive fixation was performed through an anterior midline approach using independent screws for the lateral plateau and a locked tibial intramedullary nail, whose proximal mediolateral interlocking screws contributed to reduction and fixation of the medial plateau. Passive mobilisation started on the first postoperative day, whereas weight-bearing was prohibited for 12 weeks. No infection, skin necrosis or secondary loss of reduction occurred. At the latest six-month follow-up, radiographs showed progressive union with stable implants; gait was pain-free, active flexion reached 100°, and single-leg stance was possible. Conclusion: This case illustrates the feasibility, in a carefully selected patient, of a construct combining condylar screws and a tibial nail to manage the articular, metaphyseal-diaphyseal and diaphyseal components of a Schatzker VI fracture while avoiding dual plating. However, a favourable outcome in a single patient does not justify routine early surgery through compromised soft tissues; the decision must remain individualised and accompanied by meticulous wound surveillance.