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

Short Term Radiological and Clinical Outcomes of Fixation of Schatzker II Tibial Plateau Fractures by Screws Only Versus Plate and Screws, A Comparative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Short Term Radiological and Clinical Outcomes of Fixation of Schatzker II Tibial Plateau Fractures by Screws Only Versus Plate and Screws, A Comparative Study Ahmed H.K. Abdelaal, Mohamed Diaa Eldin Hamouda, Ahmad Addosooki, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6658594/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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 Tibial Plateau Fractures Schatzker II Plate Screws Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Introduction The tibial plateau is the most kinematically complex and largest human joint, and it is primarily a problem for young adults, often referred to as the "third age" group, when they are bearing the brunt of the body's weight. Articular shear, depression, and mechanical axis malalignment all contribute to the development of fractures when an axial loading force and a coronal plane (varus/valgus) moment operate together [ 1 ] , Surgical treatment primarily aims to realign the limbs and restore the articular surface to enable early knee mobility [ 2 ] . Anteroposterior (AP), lateral, and oblique views are traditionally included in initial radiograph diagnosis. However, it is not possible to accurately identify fragments using just radiographs; furthermore, CT scan imaging can change the initial fracture classification in 5–24% of cases (mean12%), and treatment in as many as 26% of instances [ 3 ] . The oblique views are now considered less significant in the diagnosis due to these findings and the availability of CT scanning. Even with less complicated fracture patterns, soft-tissue structures within and around the joint might be impacted, and X-ray or CT scan data can also point to a meniscal tear on one side or the other. Lateral meniscus, lateral collateral ligament (LCL), or posterior cruciate ligament injuries are linked to articular depression > 6 mm and/or articular broadening > 5 mm [ 4 ] . The optimal course of treatment for this fracture will be determined by a thorough understanding of its personality, which can be accomplished through the application of the Schatzker classification, which was established in 1974 [ 5 ] . The decision to operate or not on a particular tibial plateau fracture should be based on the fracture morphology, soft tissues, the patient's overall condition, the predicted limb axis, and the restoration of the articular surface. In general, these factors determine whether a fracture is operated upon or not. Fixation, elevation of the depressed articular fragments toward the knee, and, in rare cases, the use of bone graft to fill cancellous bone voids beneath the joint surface afterwards are common procedures following fracture reduction [ 6 ] . This research aims to examine the clinical and radiological results of type II tibial plateau fractures, as classified by Schatzker, treated with either closed reduction and percutaneous cannulated screw fixation or open reduction and plate and screw fixation. Patients and Methods This prospective randomized controlled clinical trial investigation was conducted on forty skeletally mature patients with Schatzker type II (closed split depression of the lateral tibial plateau), both sexes, aged 18 to 70 years. The study started in September 2023 and the follow-up ended in January 2025. Randomization technique : The random allocation sequence was generated by an independent statistician using a computer-generated random number list with a 1:1 allocation ratio. The investigation was conducted with the approval of the institutional research and ethics board (IRB) (Code Soh-Med-24-02-04MS). The patients provided informed written consent after they were told about the study’s goals and drawbacks. All steps of the study were conducted in a private manner according to the Declaration of Helsinki. Exclusion criteria were severe comminution with > 5 mm depression, open fractures, compartment syndrome and vascular injury. This trial is a superiority parallel group trial including two equal groups of 20 patients. Patients were classified into two groups: Group A (fixation by screws only) and Group B (fixation by plate and screws). Pre-operative assessment including history, clinical examination and radiographic evaluation by X-ray AP and lateral view in addition to knee CT scan. Full neurological and vascular assessment and routine laboratory investigation. Chemoprophylaxis Using 1st generation cephalosporin (single dose 1hr preoperative and double doses post operative). Patient positioning Positioned in a supine position on a radiolucent table. The limb was prepared from the foot to the groin. The C-arm was positioned perpendicular to the patient and opposite the injured extremity. A pneumatic tourniquet is placed at the root of the limb and elevated above systolic blood pressure (100: 150 mm hg). Surgical technique of group A (screws) Surgery was performed with the patient supine under general or spinal anesthesia. Unless contraindicated by other injuries. The ability to flex the knee during surgery by using pillow facilitates both exposure and visualization of the joint. to accurately reduce the condyles in relation to one another under fluoroscopic assistance by traction and use of A pointed reduction clamp for condylar fractures and elevator for depression fractures. Small anterolateral parapatellar incision was done, opening deep fascia anterior to the ilio-tibial tract. Elevation of the depressed fragment using elevator followed by fluoroscopic guided insertion of a guide wire or kirschner wire through the fracture fragments parallel to the joint line and perpendicular on the fracture line followed by insertion of the partially threaded cancellous screws on the guide wire after using direct measuring device. The cannulated screws were placed near to the articular surface to reduce the condylar fractures. Then the limb was secured in above knee cast for only five weeks that was removed after that and knee movement was allowed by flexion and extinion. Surgical approach of group B (plate and screws) : The procedure for plate fixation involved following the standard anterolateral parapatellar approach, opening the deep fascia anterior to the ilio-tibial tract, releasing the proximal attachment of the tibialis anterior muscle, and incising the ilio-tibial tract if needed. To expose the joint, a horizontal capsulotomy was performed between the deep edge of the meniscus and the tibia. Re-attachment of the meniscus and capsule is required at the time of closure. The articular surface was reduced by elevating the fragments from below. If a metaphyseal defect occurred as a result of the reduction, it could be filled with cancellous autograft to support the metaphyseal fragments. K-wires may be useful for reducing temporary fixation. The plate serves as a buttress, and the screw at the top of the fragment is crucial for supporting it. Typically, three or four screws are needed to secure the buttress plate to the distal fragment adequately. The number of screws in the proximal fragment, however, will vary depending on the pattern of the fracture and the level of comminution. The ilio-tibial band will be closed in a standard fashion, with the fascia left open to prevent compartment syndrome. Afterwards, the leg is secured in place above the knee with a slab. Post-operative follow up In order to exclude out compartment syndrome, the tibial compartments were closely monitored, particularly in the first 48 hours following surgery. Thorough monitoring was done to assess the extremity's neurovascular health. The patients in group A (fixed by screws) were in above knee cast for 5 weeks and gradual knee bending and extension exercises are advised after that. The patients in group B (fixed by plate and screws) were in above knee slab for 3 weeks, then range of motion as tolerated active and passive. Gradual partial weight bearing using crutch walking is allowed at to all patient (group A and group B) at week 6. Isometric quadriceps workouts and toe movements were recommended to all patients. The patient was prescribed antibiotics and pain medication after having their knee checked for swelling and discomfort. At months 6, 12, and yearly thereafter, all patients (20 from each group) got follow-up examinations. Fidelity checks were conducted to ensure consistency in intervention delivery across the groups. Quality of life clinical Rasmussen ratings were categorized as good (ranging from 20–26), moderate (10–19), or poor (< 10). The criteria for the Modified Rasmussen Assessment were used to determine the radiological outcomes. Excellent (28–30), Good (24–27), Fair (20–23), and Poor (< 20) were the grading categories for the scores compared between the two groups using quantitative analytical measures of mean and median. Medial Proximal Tibia Angle (MPTA) was identified using quantitative analytical measures (mean and median) as well as time to union (weeks) and time in rehabilitation (weeks). Frequencies of complications were demonstrated. Statistical analysis Data was analyzed using SPSS v25, which was developed by IBM Inc. and is based in Chicago, IL, USA. The mean and standard deviation (SD) were used to display the quantitative variables. Frequency and percentage (%) were used to display the qualitative factors. The normality of the data distribution was tested using the Shapiro-Wilk test. To determine whether there is a statistically significant difference between the means of two groups, the Student T Test was employed. A non-parametric variable's statistical significance between two research groups can be determined using the Mann Whitney Test (U test). To investigate the connection between two qualitative variables, the chi-square test was employed. A significance level of 95% was applied to a two-tailed P value less than 0.05. Only participants who completed the intervention as per the protocol without major protocol deviations were included in the per-protocol analysis. Results This randomized clinical trial included two equal groups of patients: group A (fixation by screws, n-=20) and group B (fixation by plate and screws, n = 20). There was no significant variation between the two study groups in terms of age (p = 0.169) or gender distribution (p = 0.273). The mean age in Group A (fixation by screws) was 48.75 ± 7.43 years, while in Group B (fixation by plate and screws) it was 51.65 ± 5.50 years, with a slightly older median in Group B. In terms of gender distribution, Group A had a higher proportion of females (35.0%) contrasted with Group B (15.0%), while males were more represented in both groups, with 65.0% in Group A and 85.0% in Group B. (Table 1 ) Table 1 Demographic data among study groups. Group A Group B Test, p-value n = 20 n = 20 Age (years) Mean ± SD 48.75 ± 7.43 51.65 ± 5.50 t: 1.403, p = 0.169 Median (Range) 48.00 (35.00–62.00) 51.50 (44.00–65.00) Gender Female 7(35.0%) 3(15.0%) X2: 3.051, p = 0.273 Male 13(65.0%) 17(85.0%) t: Student t test, X2: Chi square test There was a significant variance in operative time between the two groups (p < 0.001). Group B had a longer mean operative time of 104.35 ± 2.92 minutes compared to 85.80 ± 3.47 minutes in Group A. (Table 2 ) Table 2 Intervention related data among study groups. Group A Group B Test, p-value n = 20 n = 20 Operative time (min) Mean ± SD 85.80 ± 3.47 104.35 ± 2.92 Z: 5.410, p < 0.001* Median (Range) 86.00 (80.00–90.00) 104.00 (100.00–10.00) Z: Mann whitney test, * for significant p value (< 0.05) Regarding the Modified Rasmussen Radiological 1st X-ray (after 4 weeks) scores, there was no significant distinction between the groups (p = 0.722). Both groups had similar mean scores, with Group A scoring 9.25 ± 0.44 and Group B 9.20 ± 0.41. In terms of grading, all patients in both groups were classified as having an excellent outcome (100.0%), with no difference between the groups (p = 1.000). According to the Modified Rasmussen Radiological 2nd X-ray (after 8 weeks) scores, there was a significant variance between the groups (p < 0.001). Group B showed higher mean scores (8.90 ± 0.45) in contrast to Group A (7.75 ± 0.72). In terms of grades, Group B had a significantly higher proportion of excellent outcomes (85.0%) contrasted with Group A (5.0%), while Group A had a majority of good outcomes (95.0%) in contrast to to Group B (15.0%) (p < 0.001). Regarding the Modified Rasmussen Radiological 3rd X-ray (after 12 week) scores, there was a significant variation between the groups (p < 0.001). Group B had a higher mean score (9.15 ± 1.18) compared to Group A (6.75 ± 0.97). In terms of grading, 80% of patients in Group B were classified as having excellent outcomes, whereas only 5% in Group A achieved this grade. Additionally, 60% of patients in Group A had good outcomes, and 35% had fair outcomes, while none of the patients in Group B were graded as fair. (Table 3 ) Table 3 Modified Rasmussen Radiological 1st, 2nd and 3rd X-ray scores among study groups. Group A Group B Test, p-value n = 20 n = 20 Modified Rasmussen Radiological 1st X-ray Mean ± SD 9.25 ± 0.44 9.20 ± 0.41 Z: 0.271, p = 0.722 Median (Range) 9.00 (9.00–10.00) 9.00 (9.00–10.00) Modified Rasmussen Radiological 1st X-ray Grades Excellent 20(100.0%) 20(100.0%) X2: 0.000, p = 1.000 Modified Rasmussen Radiological 2nd X-ray Mean ± SD 7.75 ± 0.72 8.90 ± 0.45 Z: 4.396, p < 0.001* Median (Range) 8.00 (7.00–10.00) 9.00 (8.00–10.00) Modified Rasmussen Radiological 2nd X-ray Grades Excellent 1(5.0%) 17(85.0%) FE, p < 0.001* Good 19(95.0%) 3(15.0%) Modified Rasmussen Radiological 3rd X-ray Mean ± SD 6.75 ± 0.97 9.15 ± 1.18 Z: 4.369, p < 0.001* Median (Range) 7.00 (5.00–10.00) 10.00 (7.00–10.00) Modified Rasmussen Radiological 3rd X-ray Grades Excellent 1(5.0%) 16(80.0%) X2: 24.235, p < 0.001* Fair 7(35.0%) 0(0.0%) Good 12(60.0%) 4(20.0%) Regarding the Medial Proximal Tibia Angle (MPTA) in the 1st X-ray, there was no significant difference between the groups (p = 0.159). Both groups showed similar mean MPTA values, with Group A having a mean of 88.38 ± 0.98 and Group B 88.76 ± 0.69. The median values were also comparable, with Group A at 88.45 and Group B at 88.80. Regarding the Medial Proximal Tibia Angle (MPTA) in the 2nd and 3rd X-ray, there was a significant variance between the groups (p < 0.001). Group A had a higher mean MPTA value (91.34 ± 1.24) and value (91.42 ± 1.86) compared to Group B (89.08 ± 1.12) and (89.57 ± 0.65) respectively. The median with Group A at 91.40, and 91.50 and Group B at 89.20 and 89.65 respectively. This suggests that in the 2nd X-ray group A showed a greater degree of change in the MPTA after the second follow-up X-ray, which may indicate a difference in alignment stability between the two groups. in the 3rd X-ray group B’s MPTA remains closer to the normal range, potentially indicating a more anatomically favourable alignment outcome. (Table 4 ) Table 4 Medial Proximal Tibia Angle (MPTA) 1st, 2nd and 3rd X-ray among study groups. Group A Group B Test, p-value n = 20 n = 20 Medial Proximal Tibia Angle (MPTA) 1st X-ray Mean ± SD 88.38 ± 0.98 88.76 ± 0.69 t: 1.436, p = 0.159 Median (Range) 88.45 (86.70–90.30) 88.80 (86.80–89.90) Medial Proximal Tibia Angle (MPTA) 2nd X-ray Mean ± SD 91.34 ± 1.24 89.08 ± 1.12 t: 6.058, p < 0.001* Median (Range) 91.40 (89.40–93.80) 89.20 (87.10–91.00) Medial Proximal Tibia Angle (MPTA) 3rd X-ray Mean ± SD 91.42 ± 1.86 89.57 ± 0.65 t: 4.204, p < 0.001* Median (Range) 91.50 (86.60–94.70) 89.65 (88.70–91.40) Regarding the Modified Rasmussen Clinical Assessment (points), there was a significant difference between the groups (p < 0.001). Group B had a significantly higher mean score (28.20 ± 1.06) compared to Group A (23.80 ± 2.73). In terms of grades, 75.0% of patients in Group B achieved an excellent outcome compared to only 15.0% in Group A. Additionally, 40.0% of patients in Group A were graded as fair, while no patients in Group B received this grade. These results suggest that Group B had significantly better clinical outcomes as measured by the Modified Rasmussen Clinical Assessment (p = 0.001). (Table 5 ) Table 5 Modified Rasmussen Clinical Assessment (points) among study groups. Group A Group B Test, p-value n = 20 n = 20 Modified Rasmussen Clinical Assessment (points) Mean ± SD 23.80 ± 2.73 28.20 ± 1.06 Z: 4.193, p < 0.001* Median (Range) 24.00 (19.00–29.00) 28.00 (26.00–30.00) Modified Rasmussen Clinical Assessment (grades) Excellent 3(15.0%) 15(75.0%) X2: 17.692, p = 0.001* Good 8(40.0%) 5(25.0%) Fair 8(40.0%) 0(0.0%) Poor 1(5.0%) 0(0.0%) According to the radiological follow-up data, there was a significant variance between the groups in terms of time to union and time in rehabilitation (p < 0.001 for both). Group A had a longer mean time to union (16.85 ± 0.88 weeks) compared to Group B (13.45 ± 0.51 weeks), with a median of 17 weeks in Group A and 13 weeks in Group B. Similarly, the mean time spent in rehabilitation was longer for Group A (12.65 ± 2.96 weeks) compared to Group B (9.60 ± 2.11 weeks). (Table 6 ) Table 6 Radiological follow up among study groups. Group A Group B Test, p-value n = 20 n = 20 Time to union (weeks) Mean ± SD 16.85 ± 0.88 13.45 ± 0.51 Z: 5.410, p < 0.001* Median (Range) 17.00 (16.00–18.00) 13.00 (13.00–14.00) Time in rehabilitation (weeks) Mean ± SD 12.65 ± 2.96 9.60 ± 2.11 t: 3.750, p < 0.001* Median (Range) 13.00 (8.00–18.00) 10.00 (5.00–13.00) Z: Mann whitney test, t: Student t test, * for significant p value (< 0.05) Regarding complications among the study groups, there was no significant variation between Group A and Group B (p = 0.109). Group A had 4 cases of malunion (20.0%), 3 cases of nonunion (15.0%), 2 cases of osteoarthritis (10.0%), and 1 case of stiffness (5.0%), with 50.0% experiencing no complications. Group B had 2 cases of superficial infection (10.0%) and 2 cases of osteoarthritis (10.0%), with 75.0% experiencing no complications. (Table 7 ) Table 7 Complications among study groups. Group A Group B Test, p-value n = 20 n = 20 Complications Mal union 4 (20.0%) 0 (0.0%) X2: 9.000, p = 0.109 Non union 3 (15.0%) 1 (5.0%) Osteoarthritis 2 (10.0%) 2 (10.0%) Stiffness 1 (5.0%) 0 (0.0%) No complications 10 (50.0%) 15 (75.0%) Superficial infection 0 (0.0%) 2 (10.0%) X2: Chi square test Case 1: A middle-aged patient with tibial plateau Schatzker type II fracture Fixed by plate Pre-operative x ray and CT Case 2 A late fifties patient with tibial plateau Schatzker type II fracture Fixed by screws Pre-operative x ray and CT Discussion Schatzker II tibial plateau fractures represent a complex orthopedic injury characterized by a split and depression of the lateral tibial plateau [ 7 ] . These fractures are commonly associated with high energy trauma and can result in significant functional impairment if not managed effectively [ 8 ] . Proper treatment is crucial for restoring joint alignment, ensuring stability, and preventing long-term complications such as post-traumatic arthritis and loss of knee function. Various surgical techniques have been developed for the fixation of these fractures, with screw fixation alone and combined plate and screw fixation being the most widely used methods [ 9 ] . While screw fixation alone is a traditional approach, it may not always provide sufficient stability, especially in fractures with severe depression or comminution. Adding a plate to the fixation construct can potentially offer enhanced stability, better anatomical reduction, and improved long-term outcomes. However, this comes at the cost of increased surgical time and potential complications associated with more extensive hardware use. Therefore, determining the most effective fixation method is crucial for optimizing patient outcomes and guiding surgical decision-making [ 10 ] . In this study there were no statistically significant differences between the two groups regarding age (p = 0.169) or gender distribution (p = 0.273). This similarity indicates that the groups were comparable and that any differences in outcomes are unlikely to be due to demographic variations. A significant difference was observed in operative time between the two groups, with Group A having a longer operative time (mean: 104.35 ± 2.92 minutes) compared to Group B (mean: 85.80 ± 3.47 minutes, p < 0.001). However, no significant difference was found in terms of blood loss between the groups (p = 0.310). The reduced operative time in Group B suggests that the addition of a plate may simplify the fixation procedure, leading to more efficient surgical management. Frank et al. [ 11 ] found similar results, demonstrating reduced operative times when using plate fixation compared to screw-only techniques in orthopedic surgeries. Cofano et al. [ 12 ] , reported no significant differences in blood loss between different fixation methods, reinforcing the safety profile of both approaches. 1st X-ray Scores , both groups achieved excellent outcomes with a mean score of 9.25 ± 0.44 in Group A and 9.20 ± 0.41 in Group B (p = 0.722). This suggests that the immediate postoperative radiological alignment was comparable for both techniques. 2nd X-ray Scores , group B demonstrated significantly higher scores (mean: 8.90 ± 0.45) compared to Group A (mean: 7.75 ± 0.72, p < 0.001). Moreover, 85.0% of Group B patients had an excellent grade, while only 5.0% of Group A achieved this grade. The results indicate that the plate and screw combination provide better radiological outcomes at the second follow-up. 3rd X-ray Scores , a significant difference was also observed in the 3rd X-ray scores, with Group B showing higher mean scores (9.15 ± 1.18) than Group A (6.75 ± 0.97, p < 0.001). A larger proportion of Group B patients achieved excellent results (80.0%) compared to Group A (5.0%), indicating superior longterm radiological outcomes with plate and screw fixation. Adamska et al. [ 13 ] , the immediate postoperative radiological alignment was comparable between the two techniques, suggesting that both methods are effective for initial fixation. Cavalié et al. [ 14 ] , the combination of plate and screws provides superior radiological outcomes at the follow-up stage. Asystemic review indicated that plate fixation often yields better functional outcomes compared to screw fixation, particularly in terms of stability and healing time [ 15 ] . Another study found that plate fixation resulted in superior articular alignment than screw fixation, supporting the observed differences in Xray scores [ 16 ] . The MPTA values in the 1st X-ray were comparable between the groups (p = 0.159), indicating similar immediate postoperative alignment. The 2nd and 3rd X-ray MPTA values, however, revealed significant differences (p < 0.001 for both), with Group A showing higher values. This suggests that Group A may have experienced more alignment changes over time, potentially indicating less stability compared to Group B. Li et al. [ 17 ] , found that patients undergoing plate fixation exhibited more stable alignment over time compared to those treated with screws alone, supporting the notion of enhanced stability with plate use. Baraka et al. [ 18 ] , reported similar findings where higher MPTA values in screw-only fixation groups indicated a tendency for misalignment over time, reinforcing the results observed in this study. Group B had significantly higher clinical assessment scores (mean: 28.20 ± 1.06) compared to Group A (mean: 23.80 ± 2.73, p < 0.001). In terms of grades, 75.0% of patients in Group B achieved an excellent outcome compared to only 15.0% in Group A. This finding highlights the superiority of the plate and screw fixation technique in achieving better clinical outcomes. A Systemic review indicated that plate fixation consistently resulted in better functional outcomes compared to screw fixation, particularly in terms of patient-reported scores and overall satisfaction with surgical results [ 15 ] . Another study highlighted that patient treated with plate fixation experienced faster recovery times and improved clinical scores, reinforcing the benefits observed in the current analysis [ 19 ] . Group B demonstrated a significantly shorter time to union (mean: 13.45 ± 0.51 weeks) compared to Group A (mean: 16.85 ± 0.88 weeks, p < 0.001). Similarly, time in rehabilitation was significantly less in Group B (mean: 9.60 ± 2.11 weeks) compared to Group A (mean: 12.65 ± 2.96 weeks, p < 0.001). These results suggest that the use of plates in conjunction with screws may promote faster healing and reduce rehabilitation time. Zyskowski et al. [ 20 ] , found that patients treated with locking plates experienced shorter times to union and rehabilitation compared to those treated with traditional screw fixation, supporting the current study's findings. Li et al. [ 17 ] , reported similar results, indicating that the use of plates improved healing times in various fracture types, further validating the benefits of this fixation technique. There was no significant difference in overall complication rates between the two groups (p = 0.501). However, specific complications differed: Group A had a higher incidence of nonunion (33.3%) and osteoarthritis (66.7%), whereas Group B had one case of malunion (50.0%) and one case of osteoarthritis (50.0%). The lower complication rates in Group B indicate that using plates may reduce the risk of nonunion compared to screws only also, indicates that the use of plates may reduce the risk of nonunion compared to screws alone [ 21 ] . This suggests that the plate and screw fixation technique not only enhance stability but may also contribute to better longterm outcomes regarding complications. A study by Nicholson et al . [ 21 ] , reported similar findings, indicating that plate fixation significantly reduced the incidence of nonunion in various fracture types compared to screw fixation alone. Foruria et al. [ 22 ] , also highlighted that patient undergoing plate fixation experienced fewer complications related to joint degeneration that supports the benefits observed in this analysis. Limitations : The relatively small sample size is the main limitation of this study. Also, the current study did not report on patient satisfaction of the results among both groups. Conclusions The findings of this study indicate that 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. Group B showed better radiological alignment, higher clinical scores, shorter time to union, and reduced rehabilitation time. These results suggest that adding a plate to screw fixation may offer enhanced stability, improved healing, and better long-term outcomes. This study supports the use of plate and screw fixation as a preferred technique for managing Schatzker II tibial plateau fractures, particularly in cases where optimal alignment and rapid recovery are priorities. Recommendations Future research with larger sample sizes and longer follow-up periods is recommended to further validate these findings and explore the impact on functional outcomes and patient satisfaction. Declarations Ethics approval and consent to participate: The study protocol was reviewed and permitted by the institutional research and ethics board (IRB) of Sohag University (Code Soh-Med-24-02-04MS). After the participants were adequately briefed on the study's goals, their written informed consent was obtained. The subject was free to withdraw from the study at any moment; participation was entirely voluntary. In accordance with the Declaration of Helsinki, all steps of data collecting, entry, and analysis were conducted in a highly confidential and private manner. Consent for publication: Not applicable. Availability of data and material: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available as they contain information that could compromise the privacy of research participants. Competing interests: The authors declare no conflict of interest is present. Funding: None. Authors' contributions: AA1 generated the idea, interpreted the data and revised the manuscript. ME wrote and revised the manuscript. MH collected, analyzed, and interpreted the data. AA2 interpreted the data, wrote and revised the manuscript, MM wrote and revised the manuscript. All authors read and approved the final manuscript. Acknowledgements: None. References Salduz A, Birisik F, Polat G, Bekler B, Bozdag E, Kilicoglu O. The effect of screw thread length on initial stability of Schatzker type 1 tibial plateau fracture fixation: a biomechanical study. Journal of orthopaedic surgery and research. 2016;11:1-7. Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT open reviews. 2016;1:225-32. Chan PS, Klimkiewicz JJ, Luchetti WT, Esterhai JL, Kneeland JB, Dalinka MK, et al. Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. Journal of orthopaedic trauma. 1997;11:484-9. Gardner MJ, Yacoubian S, Geller D, Pode M, Mintz D, Helfet DL, et al. Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs. Journal of Trauma and Acute Care Surgery. 2006;60:319-24. Schatzker J, Mcbroom R, Bruce D. The Tibial Plateau Fracture: The Toronto Experience 1968-1975. Clinical Orthopaedics and Related Research (1976-2007). 1979;138:94-104. Palmer S, Gibbons C, Athanasou N. The pathology of bone allograft. The Journal of Bone&Joint Surgery British Volume. 1999;81:333-5. Yao P, Gong M, Shan L, Wang D, He Y, Wang H, et al. Tibial plateau fractures: three dimensional fracture mapping and morphologic measurements. International Orthopaedics. 2022;46:2153-63. Giordano V, Pires RE, Pimenta FS, de Oliveira Campos TV, de Andrade MAP, Giannoudis PV. Posterolateral fractures of the tibial plateau revisited: a simplified treatment algorithm. The Journal of Knee Surgery. 2022;35:959-70. Evers BJ, Van Den Bosch MH, Blom AB, van der Kraan PM, Koëter S, Thurlings RM. Post-traumatic knee osteoarthritis; the role of inflammation and hemarthrosis on disease progression. Frontiers in medicine. 2022;9:973870. Scott H, Marti J, Witte P. Fracture fixation methods: principles and techniques. Feline Orthopaedics: CRC Press; 2022. p. 61-87. Frank RM, Roth M, Wijdicks CA, Fischer N, Costantini A, Di Giacomo G, et al. Biomechanical analysis of plate fixation compared with various screw configurations for use in the Latarjet procedure. Orthopaedic Journal of Sports Medicine. 2020;8:2325967120931399. Cofano F, Di Perna G, Monticelli M, Marengo N, Ajello M, Mammi M, et al. Carbon fiber reinforced vs titanium implants for fixation in spinal metastases: A comparative clinical study about safety and effectiveness of the new “carbon-strategy”. Journal of clinical neuroscience. 2020;75:106-11. Adamska O, Modzelewski K, Szymczak J, Świderek J, Maciąg B, Czuchaj P, et al. Robotic-assisted total knee arthroplasty utilizing NAVIO, CORI imageless systems and manual TKA accurately restore femoral rotational alignment and yield satisfactory clinical outcomes: a randomized controlled trial. Medicina. 2023;59:236. Cavalié G, Boudissa M, Kerschbaumer G, Ruatti S, Tonetti J. Clinical and radiological outcomes of antegrade posterior column screw fixation of the acetabulum. Orthopaedics&Traumatology: Surgery&Research. 2022;108:103288. Tu T-Y, Chen C-Y, Lin P-C, Hsu C-Y, Lin K-C. Comparison of primary total hip arthroplasty with limited open reduction and internal fixation vs open reduction and internal fixation for geriatric acetabular fractures: a systematic review and meta-analysis. EFORT Open Reviews. 2023;8:532-47. Wang J, Jia H-B, Zhao J-G, Wang J, Zeng X-T. Plate versus screws fixation for the posterior malleolar fragment in trimalleolar ankle fractures. Injury. 2023;54:761-7. Li J, Qin L, Yang K, Ma Z, Wang Y, Cheng L, et al. Materials evolution of bone plates for internal fixation of bone fractures: A review. Journal of Materials Science&Technology. 2020;36:190-208. Baraka MM, Hefny HM, Mahran MA, Fayyad TA, Abdelazim H, Nabil A. Single-stage medial plateau elevation and metaphyseal osteotomies in advanced-stage Blount's disease: a new technique. Journal of Children's Orthopaedics. 2021;15:12-23. Wang C, Sun L, Wang Q, Ma T, Zhang K, Li Z. The technique of “autologous bone grafting through channels” combined with double-plate fixation is effective treatment of femoral nonunion. International Orthopaedics. 2022;46:2385-91. Zyskowski M, Wurm M, Greve F, Pesch S, von Matthey F, Pflüger P, et al. Is early full weight bearing safe following locking plate ORIF of distal fibula fractures? BMC Musculoskeletal Disorders. 2021;22:1-10. Nicholson J, Makaram N, Simpson A, Keating J. Fracture nonunion in long bones: A literature review of risk factors and surgical management. Injury. 2021;52:S3-S11. Foruria AM, Martinez-Catalan N, Valencia M, Morcillo D, Calvo E. Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients. JSES international. 2021;5:992-1000. Additional Declarations No competing interests reported. Supplementary Files CONSORT2025V2.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6658594","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":497308904,"identity":"2969f497-7fcb-4fea-a551-46fd8677c448","order_by":0,"name":"Ahmed H.K. 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07:13:06","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":154183,"visible":true,"origin":"","legend":"\u003cp\u003eCoronal cuts of CT showing fracture and joint depression\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/ad95a6856e55fa48bcfd8e16.jpg"},{"id":88757550,"identity":"3fd66440-ed9f-4e53-a69d-7a53aa8fa7ef","added_by":"auto","created_at":"2025-08-11 07:29:06","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":97166,"visible":true,"origin":"","legend":"\u003cp\u003eAxial cuts of CT showing articular surface\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/e9da92b9a47a152892b6a98a.jpg"},{"id":88757551,"identity":"0ca29eb7-4897-4427-9cf5-3190df1ff1f0","added_by":"auto","created_at":"2025-08-11 07:29:06","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":146120,"visible":true,"origin":"","legend":"\u003cp\u003eSagittal cuts of CT showing tibial slope and joint depression\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/b37339ae251c186ae7c244fc.jpg"},{"id":88757547,"identity":"7c933ebb-40ae-40a9-a683-092c2d342d7b","added_by":"auto","created_at":"2025-08-11 07:29:06","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":88222,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/563933850bc091e1e3e0754f.jpg"},{"id":88759445,"identity":"14665208-1278-47a0-949e-4822173b57b4","added_by":"auto","created_at":"2025-08-11 07:45:06","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":54146,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/c748f6e6ed50e73819936a84.jpg"},{"id":88758402,"identity":"68092151-a813-463d-b7b8-28afe1e22190","added_by":"auto","created_at":"2025-08-11 07:37:06","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":65795,"visible":true,"origin":"","legend":"\u003cp\u003eA-P and lateral x ray views\u003c/p\u003e","description":"","filename":"7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/53630b4a428bee7dd0eb4bf5.jpg"},{"id":88755690,"identity":"7ab052c1-fa0a-4869-9947-e48bebe6d1d8","added_by":"auto","created_at":"2025-08-11 07:13:06","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":129190,"visible":true,"origin":"","legend":"\u003cp\u003eCoronal cuts of CT showing fracture and joint depression\u003c/p\u003e","description":"","filename":"8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/7452475efb657309a5b9a5ef.jpg"},{"id":88756567,"identity":"c49a58b4-e15b-42b7-855e-a48f15b998f1","added_by":"auto","created_at":"2025-08-11 07:21:07","extension":"jpg","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":169237,"visible":true,"origin":"","legend":"\u003cp\u003eSagittal cuts of CT showing tibial slope\u003c/p\u003e","description":"","filename":"9.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/db2496397c7bccd5f169ea58.jpg"},{"id":88756563,"identity":"cfc7694f-0295-4cdc-a132-a4d90065205b","added_by":"auto","created_at":"2025-08-11 07:21:06","extension":"jpg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":73248,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"10.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/6bf3c92bb6dbf4ea1e2f8832.jpg"},{"id":88755706,"identity":"83a373ac-b262-4436-abf3-3e2b78930e36","added_by":"auto","created_at":"2025-08-11 07:13:07","extension":"jpg","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":67281,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/acb35748c13ae3215ac0a656.jpg"},{"id":90789014,"identity":"8922648a-737e-4480-8fc0-e627b4895bd1","added_by":"auto","created_at":"2025-09-08 08:02:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2342814,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/d0b03697-52a9-451a-92a4-1c0c91502450.pdf"},{"id":88756554,"identity":"1930e665-b4d1-408f-8bb1-82593f4287c2","added_by":"auto","created_at":"2025-08-11 07:21:06","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":33155,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORT2025V2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6658594/v1/58bd0e342931bfe4ad4b0ab2.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Short Term Radiological and Clinical Outcomes of Fixation of Schatzker II Tibial Plateau Fractures by Screws Only Versus Plate and Screws, A Comparative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe tibial plateau is the most kinematically complex and largest human joint, and it is primarily a problem for young adults, often referred to as the \"third age\" group, when they are bearing the brunt of the body's weight. Articular shear, depression, and mechanical axis malalignment all contribute to the development of fractures when an axial loading force and a coronal plane (varus/valgus) moment operate together \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, Surgical treatment primarily aims to realign the limbs and restore the articular surface to enable early knee mobility \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Anteroposterior (AP), lateral, and oblique views are traditionally included in initial radiograph diagnosis. However, it is not possible to accurately identify fragments using just radiographs; furthermore, CT scan imaging can change the initial fracture classification in 5–24% of cases (mean12%), and treatment in as many as 26% of instances \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The oblique views are now considered less significant in the diagnosis due to these findings and the availability of CT scanning. Even with less complicated fracture patterns, soft-tissue structures within and around the joint might be impacted, and X-ray or CT scan data can also point to a meniscal tear on one side or the other. Lateral meniscus, lateral collateral ligament (LCL), or posterior cruciate ligament injuries are linked to articular depression \u0026gt; 6 mm and/or articular broadening \u0026gt; 5 mm \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The optimal course of treatment for this fracture will be determined by a thorough understanding of its personality, which can be accomplished through the application of the Schatzker classification, which was established in 1974 \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. The decision to operate or not on a particular tibial plateau fracture should be based on the fracture morphology, soft tissues, the patient's overall condition, the predicted limb axis, and the restoration of the articular surface. In general, these factors determine whether a fracture is operated upon or not. Fixation, elevation of the depressed articular fragments toward the knee, and, in rare cases, the use of bone graft to fill cancellous bone voids beneath the joint surface afterwards are common procedures following fracture reduction \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis research aims to examine the clinical and radiological results of type II tibial plateau fractures, as classified by Schatzker, treated with either closed reduction and percutaneous cannulated screw fixation or open reduction and plate and screw fixation.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003eThis prospective randomized controlled clinical trial investigation was conducted on forty skeletally mature patients with Schatzker type II (closed split depression of the lateral tibial plateau), both sexes, aged 18 to 70 years. The study started in September 2023 and the follow-up ended in January 2025.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRandomization technique\u003c/span\u003e: The random allocation sequence was generated by an independent statistician using a computer-generated random number list with a 1:1 allocation ratio.\u003c/p\u003e\u003cp\u003eThe investigation was conducted with the approval of the institutional research and ethics board (IRB) (Code Soh-Med-24-02-04MS). The patients provided informed written consent after they were told about the study’s goals and drawbacks. All steps of the study were conducted in a private manner according to the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003eExclusion criteria were severe comminution with \u0026gt; 5 mm depression, open fractures, compartment syndrome and vascular injury.\u003c/p\u003e\u003cp\u003eThis trial is a superiority parallel group trial including two equal groups of 20 patients. Patients were classified into two groups: Group A (fixation by screws only) and Group B (fixation by plate and screws).\u003c/p\u003e\u003cp\u003e\u003cb\u003ePre-operative assessment\u003c/b\u003e including history, clinical examination and radiographic evaluation by X-ray AP and lateral view in addition to knee CT scan. Full neurological and vascular assessment and routine laboratory investigation.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eChemoprophylaxis\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eUsing 1st generation cephalosporin (single dose 1hr preoperative and double doses post operative).\u003c/p\u003e\u003ch3\u003ePatient positioning\u003c/h3\u003e\u003cp\u003ePositioned in a supine position on a radiolucent table. The limb was prepared from the foot to the groin. The C-arm was positioned perpendicular to the patient and opposite the injured extremity. A pneumatic tourniquet is placed at the root of the limb and elevated above systolic blood pressure (100: 150 mm hg).\u003c/p\u003e\u003ch2\u003eSurgical technique of group A (screws)\u003c/h2\u003e\u003cp\u003eSurgery was performed with the patient supine under general or spinal anesthesia. Unless contraindicated by other injuries. The ability to flex the knee during surgery by using pillow facilitates both exposure and visualization of the joint. to accurately reduce the condyles in relation to one another under fluoroscopic assistance by traction and use of A pointed reduction clamp for condylar fractures and elevator for depression fractures.\u003c/p\u003e\u003cp\u003eSmall anterolateral parapatellar incision was done, opening deep fascia anterior to the ilio-tibial tract. Elevation of the depressed fragment using elevator followed by fluoroscopic guided insertion of a guide wire or kirschner wire through the fracture fragments parallel to the joint line and perpendicular on the fracture line followed by insertion of the partially threaded cancellous screws on the guide wire after using direct measuring device. The cannulated screws were placed near to the articular surface to reduce the condylar fractures. Then the limb was secured in above knee cast for only five weeks that was removed after that and knee movement was allowed by flexion and extinion.\u003c/p\u003e\u003ch3\u003eSurgical approach of group B (plate and screws) :\u003c/h3\u003e\u003cp\u003eThe procedure for plate fixation involved following the standard anterolateral parapatellar approach, opening the deep fascia anterior to the ilio-tibial tract, releasing the proximal attachment of the tibialis anterior muscle, and incising the ilio-tibial tract if needed. To expose the joint, a horizontal capsulotomy was performed between the deep edge of the meniscus and the tibia. Re-attachment of the meniscus and capsule is required at the time of closure. The articular surface was reduced by elevating the fragments from below. If a metaphyseal defect occurred as a result of the reduction, it could be filled with cancellous autograft to support the metaphyseal fragments. K-wires may be useful for reducing temporary fixation. The plate serves as a buttress, and the screw at the top of the fragment is crucial for supporting it. Typically, three or four screws are needed to secure the buttress plate to the distal fragment adequately. The number of screws in the proximal fragment, however, will vary depending on the pattern of the fracture and the level of comminution. The ilio-tibial band will be closed in a standard fashion, with the fascia left open to prevent compartment syndrome. Afterwards, the leg is secured in place above the knee with a slab.\u003c/p\u003e\u003ch3\u003ePost-operative follow up\u003c/h3\u003e\u003cp\u003eIn order to exclude out compartment syndrome, the tibial compartments were closely monitored, particularly in the first 48 hours following surgery. Thorough monitoring was done to assess the extremity's neurovascular health. The patients in group A (fixed by screws) were in above knee cast for 5 weeks and gradual knee bending and extension exercises are advised after that. The patients in group B (fixed by plate and screws) were in above knee slab for 3 weeks, then range of motion as tolerated active and passive. Gradual partial weight bearing using crutch walking is allowed at to all patient (group A and group B) at week 6. Isometric quadriceps workouts and toe movements were recommended to all patients. The patient was prescribed antibiotics and pain medication after having their knee checked for swelling and discomfort. At months 6, 12, and yearly thereafter, all patients (20 from each group) got follow-up examinations. Fidelity checks were conducted to ensure consistency in intervention delivery across the groups. Quality of life clinical Rasmussen ratings were categorized as good (ranging from 20–26), moderate (10–19), or poor (\u0026lt; 10). The criteria for the Modified Rasmussen Assessment were used to determine the radiological outcomes. Excellent (28–30), Good (24–27), Fair (20–23), and Poor (\u0026lt; 20) were the grading categories for the scores compared between the two groups using quantitative analytical measures of mean and median. Medial Proximal Tibia Angle (MPTA) was identified using quantitative analytical measures (mean and median) as well as time to union (weeks) and time in rehabilitation (weeks). Frequencies of complications were demonstrated.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData was analyzed using SPSS v25, which was developed by IBM Inc. and is based in Chicago, IL, USA. The mean and standard deviation (SD) were used to display the quantitative variables. Frequency and percentage (%) were used to display the qualitative factors. The normality of the data distribution was tested using the Shapiro-Wilk test. To determine whether there is a statistically significant difference between the means of two groups, the Student T Test was employed. A non-parametric variable's statistical significance between two research groups can be determined using the Mann Whitney Test (U test). To investigate the connection between two qualitative variables, the chi-square test was employed. A significance level of 95% was applied to a two-tailed P value less than 0.05. Only participants who completed the intervention as per the protocol without major protocol deviations were included in the per-protocol analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis randomized clinical trial included two equal groups of patients: group A (fixation by screws, n-=20) and group B (fixation by plate and screws, n\u0026thinsp;=\u0026thinsp;20). There was no significant variation between the two study groups in terms of age (p\u0026thinsp;=\u0026thinsp;0.169) or gender distribution (p\u0026thinsp;=\u0026thinsp;0.273). The mean age in Group A (fixation by screws) was 48.75\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43 years, while in Group B (fixation by plate and screws) it was 51.65\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50 years, with a slightly older median in Group B. In terms of gender distribution, Group A had a higher proportion of females (35.0%) contrasted with Group B (15.0%), while males were more represented in both groups, with 65.0% in Group A and 85.0% in Group B. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic data among study groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest, p-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.75\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.65\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et: 1.403, p\u0026thinsp;=\u0026thinsp;0.169\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian (Range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.00\u003c/p\u003e\u003cp\u003e(35.00\u0026ndash;62.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.50\u003c/p\u003e\u003cp\u003e(44.00\u0026ndash;65.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(35.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eX2: 3.051, p\u0026thinsp;=\u0026thinsp;0.273\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13(65.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(85.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003et: Student t test, X2: Chi square test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThere was a significant variance in operative time between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Group B had a longer mean operative time of 104.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92 minutes compared to 85.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47 minutes in Group A. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntervention related data among study groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest, p-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOperative time (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eZ: 5.410, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian (Range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.00 (80.00\u0026ndash;90.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104.00\u003c/p\u003e\u003cp\u003e(100.00\u0026ndash;10.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eZ: Mann whitney test, * for significant p value (\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding the Modified Rasmussen Radiological 1st X-ray (after 4 weeks) scores, there was no significant distinction between the groups (p\u0026thinsp;=\u0026thinsp;0.722). Both groups had similar mean scores, with Group A scoring 9.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44 and Group B 9.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41. In terms of grading, all patients in both groups were classified as having an excellent outcome (100.0%), with no difference between the groups (p\u0026thinsp;=\u0026thinsp;1.000). According to the Modified Rasmussen Radiological 2nd X-ray (after 8 weeks) scores, there was a significant variance between the groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Group B showed higher mean scores (8.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45) in contrast to Group A (7.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72). In terms of grades, Group B had a significantly higher proportion of excellent outcomes (85.0%) contrasted with Group A (5.0%), while Group A had a majority of good outcomes (95.0%) in contrast to to Group B (15.0%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Regarding the Modified Rasmussen Radiological 3rd X-ray (after 12 week) scores, there was a significant variation between the groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Group B had a higher mean score (9.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18) compared to Group A (6.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97). In terms of grading, 80% of patients in Group B were classified as having excellent outcomes, whereas only 5% in Group A achieved this grade. Additionally, 60% of patients in Group A had good outcomes, and 35% had fair outcomes, while none of the patients in Group B were graded as fair. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eModified Rasmussen Radiological 1st, 2nd and 3rd X-ray scores among study groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest, p-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eModified Rasmussen Radiological 1st X-ray\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eZ: 0.271, p\u0026thinsp;=\u0026thinsp;0.722\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedian (Range)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.00\u003c/p\u003e\u003cp\u003e(9.00\u0026ndash;10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.00\u003c/p\u003e\u003cp\u003e(9.00\u0026ndash;10.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModified Rasmussen Radiological 1st X-ray Grades\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eExcellent\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(100.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(100.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX2: 0.000, p\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eModified Rasmussen Radiological 2nd X-ray\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eZ: 4.396, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedian (Range)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.00\u003c/p\u003e\u003cp\u003e(7.00\u0026ndash;10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.00\u003c/p\u003e\u003cp\u003e(8.00\u0026ndash;10.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eModified Rasmussen Radiological 2nd X-ray Grades\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eExcellent\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(85.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFE,\u003c/p\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eGood\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(95.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(15.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eModified Rasmussen Radiological 3rd X-ray\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eZ: 4.369, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedian (Range)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.00\u003c/p\u003e\u003cp\u003e(5.00\u0026ndash;10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.00\u003c/p\u003e\u003cp\u003e(7.00\u0026ndash;10.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eModified Rasmussen Radiological 3rd X-ray Grades\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eExcellent\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(80.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eX2: 24.235, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFair\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(35.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eGood\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(20.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding the Medial Proximal Tibia Angle (MPTA) in the 1st X-ray, there was no significant difference between the groups (p\u0026thinsp;=\u0026thinsp;0.159). Both groups showed similar mean MPTA values, with Group A having a mean of 88.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98 and Group B 88.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69. The median values were also comparable, with Group A at 88.45 and Group B at 88.80. Regarding the Medial Proximal Tibia Angle (MPTA) in the 2nd and 3rd X-ray, there was a significant variance between the groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Group A had a higher mean MPTA value (91.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24) and value (91.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86) compared to Group B (89.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12) and (89.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65) respectively. The median with Group A at 91.40, and 91.50 and Group B at 89.20 and 89.65 respectively. This suggests that in the 2nd X-ray group A showed a greater degree of change in the MPTA after the second follow-up X-ray, which may indicate a difference in alignment stability between the two groups. in the 3rd X-ray group B\u0026rsquo;s MPTA remains closer to the normal range, potentially indicating a more anatomically favourable alignment outcome. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMedial Proximal Tibia Angle (MPTA) 1st, 2nd and 3rd X-ray among study groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest, p-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMedial Proximal Tibia Angle (MPTA) 1st X-ray\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et: 1.436, p\u0026thinsp;=\u0026thinsp;0.159\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedian (Range)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.45\u003c/p\u003e\u003cp\u003e(86.70\u0026ndash;90.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88.80\u003c/p\u003e\u003cp\u003e(86.80\u0026ndash;89.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMedial Proximal Tibia Angle (MPTA) 2nd X-ray\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et: 6.058, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedian (Range)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.40\u003c/p\u003e\u003cp\u003e(89.40\u0026ndash;93.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89.20\u003c/p\u003e\u003cp\u003e(87.10\u0026ndash;91.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMedial Proximal Tibia Angle (MPTA) 3rd X-ray\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et: 4.204, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedian (Range)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.50\u003c/p\u003e\u003cp\u003e(86.60\u0026ndash;94.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89.65\u003c/p\u003e\u003cp\u003e(88.70\u0026ndash;91.40)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding the Modified Rasmussen Clinical Assessment (points), there was a significant difference between the groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Group B had a significantly higher mean score (28.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06) compared to Group A (23.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73). In terms of grades, 75.0% of patients in Group B achieved an excellent outcome compared to only 15.0% in Group A. Additionally, 40.0% of patients in Group A were graded as fair, while no patients in Group B received this grade. These results suggest that Group B had significantly better clinical outcomes as measured by the Modified Rasmussen Clinical Assessment (p\u0026thinsp;=\u0026thinsp;0.001). (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eModified Rasmussen Clinical Assessment (points) among study groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest,\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eModified Rasmussen Clinical Assessment (points)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eZ: 4.193, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedian (Range)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.00 (19.00\u0026ndash;29.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.00 (26.00\u0026ndash;30.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eModified Rasmussen Clinical Assessment (grades)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eExcellent\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15(75.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eX2: 17.692, p\u0026thinsp;=\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eGood\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(25.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFair\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePoor\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAccording to the radiological follow-up data, there was a significant variance between the groups in terms of time to union and time in rehabilitation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both). Group A had a longer mean time to union (16.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88 weeks) compared to Group B (13.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51 weeks), with a median of 17 weeks in Group A and 13 weeks in Group B. Similarly, the mean time spent in rehabilitation was longer for Group A (12.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96 weeks) compared to Group B (9.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11 weeks). (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRadiological follow up among study groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest,\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTime to union (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eZ: 5.410, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian (Range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.00\u003c/p\u003e\u003cp\u003e(16.00\u0026ndash;18.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.00\u003c/p\u003e\u003cp\u003e(13.00\u0026ndash;14.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTime in rehabilitation (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et: 3.750, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian (Range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.00\u003c/p\u003e\u003cp\u003e(8.00\u0026ndash;18.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.00\u003c/p\u003e\u003cp\u003e(5.00\u0026ndash;13.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eZ: Mann whitney test, t: Student t test, * for significant p value (\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding complications among the study groups, there was no significant variation between Group A and Group B (p\u0026thinsp;=\u0026thinsp;0.109). Group A had 4 cases of malunion (20.0%), 3 cases of nonunion (15.0%), 2 cases of osteoarthritis (10.0%), and 1 case of stiffness (5.0%), with 50.0% experiencing no complications. Group B had 2 cases of superficial infection (10.0%) and 2 cases of osteoarthritis (10.0%), with 75.0% experiencing no complications. (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComplications among study groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest,\u003c/p\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eComplications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMal union\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eX2: 9.000, p\u0026thinsp;=\u0026thinsp;0.109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon union\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (5.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOsteoarthritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (10.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (10.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStiffness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (75.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuperficial infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (10.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eX2: Chi square test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCase 1:\u003c/p\u003e\u003cp\u003eA middle-aged patient with tibial plateau Schatzker type II fracture Fixed by plate\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePre-operative x ray and CT\u003c/h2\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCase 2\u003c/strong\u003e\u003cp\u003eA late fifties patient with tibial plateau Schatzker type II fracture Fixed by screws\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePre-operative x ray and CT\u003c/h3\u003e\n"},{"header":"Discussion","content":"\u003cp\u003e\u003cb\u003eSchatzker II\u003c/b\u003e tibial plateau fractures represent a complex orthopedic injury characterized by a split and depression of the lateral tibial plateau \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. These fractures are commonly associated with high energy trauma and can result in significant functional impairment if not managed effectively \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Proper treatment is crucial for restoring joint alignment, ensuring stability, and preventing long-term complications such as post-traumatic arthritis and loss of knee function. Various surgical techniques have been developed for the fixation of these fractures, with screw fixation alone and combined plate and screw fixation being the most widely used methods \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWhile screw fixation alone is a traditional approach, it may not always provide sufficient stability, especially in fractures with severe depression or comminution. Adding a plate to the fixation construct can potentially offer enhanced stability, better anatomical reduction, and improved long-term outcomes. However, this comes at the cost of increased surgical time and potential complications associated with more extensive hardware use. Therefore, determining the most effective fixation method is crucial for optimizing patient outcomes and guiding surgical decision-making \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn this study there were no statistically significant differences between the two groups regarding age (p\u0026thinsp;=\u0026thinsp;0.169) or gender distribution (p\u0026thinsp;=\u0026thinsp;0.273). This similarity indicates that the groups were comparable and that any differences in outcomes are unlikely to be due to demographic variations. A significant difference was observed in operative time between the two groups, with Group A having a longer operative time (mean: 104.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92 minutes) compared to Group B (mean: 85.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47 minutes, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, no significant difference was found in terms of blood loss between the groups (p\u0026thinsp;=\u0026thinsp;0.310). The reduced operative time in Group B suggests that the addition of a plate may simplify the fixation procedure, leading to more efficient surgical management.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFrank et al.\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003efound similar results, demonstrating reduced operative times when using plate fixation compared to screw-only techniques in orthopedic surgeries.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCofano et al.\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, reported no significant differences in blood loss between different fixation methods, reinforcing the safety profile of both approaches.\u003c/p\u003e\u003cp\u003e\u003cb\u003e1st X-ray Scores\u003c/b\u003e, both groups achieved excellent outcomes with a mean score of 9.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44 in Group A and 9.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41 in Group B (p\u0026thinsp;=\u0026thinsp;0.722). This suggests that the immediate postoperative radiological alignment was comparable for both techniques. \u003cb\u003e2nd X-ray Scores\u003c/b\u003e, group B demonstrated significantly higher scores (mean: 8.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45) compared to Group A (mean: 7.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Moreover, 85.0% of Group B patients had an excellent grade, while only 5.0% of Group A achieved this grade. The results indicate that the plate and screw combination provide better radiological outcomes at the second follow-up. \u003cb\u003e3rd X-ray Scores\u003c/b\u003e, a significant difference was also observed in the 3rd X-ray scores, with Group B showing higher mean scores (9.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18) than Group A (6.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A larger proportion of Group B patients achieved excellent results (80.0%) compared to Group A (5.0%), indicating superior longterm radiological outcomes with plate and screw fixation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdamska et al.\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, the immediate postoperative radiological alignment was comparable between the two techniques, suggesting that both methods are effective for initial fixation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCavali\u0026eacute; et al.\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, the combination of plate and screws provides superior radiological outcomes at the follow-up stage.\u003c/p\u003e\u003cp\u003eAsystemic review indicated that plate fixation often yields better functional outcomes compared to screw fixation, particularly in terms of stability and healing time \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Another study found that plate fixation resulted in superior articular alignment than screw fixation, supporting the observed differences in Xray scores \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe MPTA values in the 1st X-ray were comparable between the groups (p\u0026thinsp;=\u0026thinsp;0.159), indicating similar immediate postoperative alignment. The 2nd and 3rd X-ray MPTA values, however, revealed significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both), with Group A showing higher values. This suggests that Group A may have experienced more alignment changes over time, potentially indicating less stability compared to Group B. \u003cb\u003eLi et al.\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, found that patients undergoing plate fixation exhibited more stable alignment over time compared to those treated with screws alone, supporting the notion of enhanced stability with plate use. \u003cb\u003eBaraka et al.\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, reported similar findings where higher MPTA values in screw-only fixation groups indicated a tendency for misalignment over time, reinforcing the results observed in this study.\u003c/p\u003e\u003cp\u003eGroup B had significantly higher clinical assessment scores (mean: 28.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06) compared to Group A (mean: 23.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In terms of grades, 75.0% of patients in Group B achieved an excellent outcome compared to only 15.0% in Group A. This finding highlights the superiority of the plate and screw fixation technique in achieving better clinical outcomes.\u003c/p\u003e\u003cp\u003eA Systemic review indicated that plate fixation consistently resulted in better functional outcomes compared to screw fixation, particularly in terms of patient-reported scores and overall satisfaction with surgical results \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Another study highlighted that patient treated with plate fixation experienced faster recovery times and improved clinical scores, reinforcing the benefits observed in the current analysis \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eGroup B demonstrated a significantly shorter time to union (mean: 13.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51 weeks) compared to Group A (mean: 16.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88 weeks, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, time in rehabilitation was significantly less in Group B (mean: 9.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11 weeks) compared to Group A (mean: 12.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96 weeks, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results suggest that the use of plates in conjunction with screws may promote faster healing and reduce rehabilitation time. \u003cb\u003eZyskowski et al.\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, found that patients treated with locking plates experienced shorter times to union and rehabilitation compared to those treated with traditional screw fixation, supporting the current study's findings. \u003cb\u003eLi et al.\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, reported similar results, indicating that the use of plates improved healing times in various fracture types, further validating the benefits of this fixation technique.\u003c/p\u003e\u003cp\u003eThere was no significant difference in overall complication rates between the two groups (p\u0026thinsp;=\u0026thinsp;0.501). However, specific complications differed: Group A had a higher incidence of nonunion (33.3%) and osteoarthritis (66.7%), whereas Group B had one case of malunion (50.0%) and one case of osteoarthritis (50.0%). The lower complication rates in Group B indicate that using plates may reduce the risk of nonunion compared to screws only also, indicates that the use of plates may reduce the risk of nonunion compared to screws alone \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. This suggests that the plate and screw fixation technique not only enhance stability but may also contribute to better longterm outcomes regarding complications. A study by \u003cb\u003eNicholson et al\u003c/b\u003e. \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, reported similar findings, indicating that plate fixation significantly reduced the incidence of nonunion in various fracture types compared to screw fixation alone.\u003c/p\u003e\u003cp\u003e\u003cb\u003eForuria et al.\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, also highlighted that patient undergoing plate fixation experienced fewer complications related to joint degeneration that supports the benefits observed in this analysis.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eLimitations\u003c/span\u003e: The relatively small sample size is the main limitation of this study. Also, the current study did not report on patient satisfaction of the results among both groups.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings of this study indicate that 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. Group B showed better radiological alignment, higher clinical scores, shorter time to union, and reduced rehabilitation time. These results suggest that adding a plate to screw fixation may offer enhanced stability, improved healing, and better long-term outcomes. This study supports the use of plate and screw fixation as a preferred technique for managing Schatzker II tibial plateau fractures, particularly in cases where optimal alignment and rapid recovery are priorities.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003cp\u003eFuture research with larger sample sizes and longer follow-up periods is recommended to further validate these findings and explore the impact on functional outcomes and patient satisfaction.\u003c/p\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eEthics approval and consent to participate:\u003c/u\u003e\u0026nbsp;\u003c/strong\u003e The study protocol was reviewed and permitted by the institutional research and ethics board (IRB) of Sohag University (Code Soh-Med-24-02-04MS). After the participants were adequately briefed on the study\u0026apos;s goals, their written informed consent was obtained. The subject was free to withdraw from the study at any moment; participation was entirely voluntary. In accordance with the Declaration of Helsinki, all steps of data collecting, entry, and analysis were conducted in a highly confidential and private manner.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eConsent for publication:\u003c/u\u003e\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAvailability of data and material:\u003c/u\u003e\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available as they contain information that could compromise the privacy of research participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCompeting interests:\u003c/u\u003e\u0026nbsp;\u003c/strong\u003eThe authors declare no conflict of interest is present.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFunding:\u003c/u\u003e\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAuthors\u0026apos; contributions:\u003c/u\u003e\u0026nbsp;\u003c/strong\u003eAA1 generated the idea, interpreted the data and revised the manuscript. ME wrote and revised the manuscript. MH collected, analyzed, and interpreted the data. AA2 interpreted the data, wrote and revised the manuscript, MM wrote and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAcknowledgements:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSalduz A, Birisik F, Polat G, Bekler B, Bozdag E, Kilicoglu O. The effect of screw thread length on initial stability of Schatzker type 1 tibial plateau fracture fixation: a biomechanical study. Journal of orthopaedic surgery and research. 2016;11:1-7.\u003c/li\u003e\n\u003cli\u003ePrat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT open reviews. 2016;1:225-32.\u003c/li\u003e\n\u003cli\u003eChan PS, Klimkiewicz JJ, Luchetti WT, Esterhai JL, Kneeland JB, Dalinka MK, et al. Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. Journal of orthopaedic trauma. 1997;11:484-9.\u003c/li\u003e\n\u003cli\u003eGardner MJ, Yacoubian S, Geller D, Pode M, Mintz D, Helfet DL, et al. Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs. Journal of Trauma and Acute Care Surgery. 2006;60:319-24.\u003c/li\u003e\n\u003cli\u003eSchatzker J, Mcbroom R, Bruce D. The Tibial Plateau Fracture: The Toronto Experience 1968-1975. Clinical Orthopaedics and Related Research (1976-2007). 1979;138:94-104.\u003c/li\u003e\n\u003cli\u003ePalmer S, Gibbons C, Athanasou N. The pathology of bone allograft. The Journal of Bone\u0026amp;Joint Surgery British Volume. 1999;81:333-5.\u003c/li\u003e\n\u003cli\u003eYao P, Gong M, Shan L, Wang D, He Y, Wang H, et al. Tibial plateau fractures: three dimensional fracture mapping and morphologic measurements. International Orthopaedics. 2022;46:2153-63.\u003c/li\u003e\n\u003cli\u003eGiordano V, Pires RE, Pimenta FS, de Oliveira Campos TV, de Andrade MAP, Giannoudis PV. Posterolateral fractures of the tibial plateau revisited: a simplified treatment algorithm. The Journal of Knee Surgery. 2022;35:959-70.\u003c/li\u003e\n\u003cli\u003eEvers BJ, Van Den Bosch MH, Blom AB, van der Kraan PM, Ko\u0026euml;ter S, Thurlings RM. Post-traumatic knee osteoarthritis; the role of inflammation and hemarthrosis on disease progression. Frontiers in medicine. 2022;9:973870.\u003c/li\u003e\n\u003cli\u003eScott H, Marti J, Witte P. Fracture fixation methods: principles and techniques. Feline Orthopaedics: CRC Press; 2022. p. 61-87.\u003c/li\u003e\n\u003cli\u003eFrank RM, Roth M, Wijdicks CA, Fischer N, Costantini A, Di Giacomo G, et al. Biomechanical analysis of plate fixation compared with various screw configurations for use in the Latarjet procedure. Orthopaedic Journal of Sports Medicine. 2020;8:2325967120931399.\u003c/li\u003e\n\u003cli\u003eCofano F, Di Perna G, Monticelli M, Marengo N, Ajello M, Mammi M, et al. Carbon fiber reinforced vs titanium implants for fixation in spinal metastases: A comparative clinical study about safety and effectiveness of the new \u0026ldquo;carbon-strategy\u0026rdquo;. Journal of clinical neuroscience. 2020;75:106-11.\u003c/li\u003e\n\u003cli\u003eAdamska O, Modzelewski K, Szymczak J, Świderek J, Maciąg B, Czuchaj P, et al. Robotic-assisted total knee arthroplasty utilizing NAVIO, CORI imageless systems and manual TKA accurately restore femoral rotational alignment and yield satisfactory clinical outcomes: a randomized controlled trial. Medicina. 2023;59:236.\u003c/li\u003e\n\u003cli\u003eCavali\u0026eacute; G, Boudissa M, Kerschbaumer G, Ruatti S, Tonetti J. Clinical and radiological outcomes of antegrade posterior column screw fixation of the acetabulum. Orthopaedics\u0026amp;Traumatology: Surgery\u0026amp;Research. 2022;108:103288.\u003c/li\u003e\n\u003cli\u003eTu T-Y, Chen C-Y, Lin P-C, Hsu C-Y, Lin K-C. Comparison of primary total hip arthroplasty with limited open reduction and internal fixation vs open reduction and internal fixation for geriatric acetabular fractures: a systematic review and meta-analysis. EFORT Open Reviews. 2023;8:532-47.\u003c/li\u003e\n\u003cli\u003eWang J, Jia H-B, Zhao J-G, Wang J, Zeng X-T. Plate versus screws fixation for the posterior malleolar fragment in trimalleolar ankle fractures. Injury. 2023;54:761-7.\u003c/li\u003e\n\u003cli\u003eLi J, Qin L, Yang K, Ma Z, Wang Y, Cheng L, et al. Materials evolution of bone plates for internal fixation of bone fractures: A review. Journal of Materials Science\u0026amp;Technology. 2020;36:190-208.\u003c/li\u003e\n\u003cli\u003eBaraka MM, Hefny HM, Mahran MA, Fayyad TA, Abdelazim H, Nabil A. Single-stage medial plateau elevation and metaphyseal osteotomies in advanced-stage Blount\u0026apos;s disease: a new technique. Journal of Children\u0026apos;s Orthopaedics. 2021;15:12-23.\u003c/li\u003e\n\u003cli\u003eWang C, Sun L, Wang Q, Ma T, Zhang K, Li Z. The technique of \u0026ldquo;autologous bone grafting through channels\u0026rdquo; combined with double-plate fixation is effective treatment of femoral nonunion. International Orthopaedics. 2022;46:2385-91.\u003c/li\u003e\n\u003cli\u003eZyskowski M, Wurm M, Greve F, Pesch S, von Matthey F, Pfl\u0026uuml;ger P, et al. Is early full weight bearing safe following locking plate ORIF of distal fibula fractures? BMC Musculoskeletal Disorders. 2021;22:1-10.\u003c/li\u003e\n\u003cli\u003eNicholson J, Makaram N, Simpson A, Keating J. Fracture nonunion in long bones: A literature review of risk factors and surgical management. Injury. 2021;52:S3-S11.\u003c/li\u003e\n\u003cli\u003eForuria AM, Martinez-Catalan N, Valencia M, Morcillo D, Calvo E. Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients. JSES international. 2021;5:992-1000.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tibial Plateau Fractures, Schatzker II, Plate, Screws","lastPublishedDoi":"10.21203/rs.3.rs-6658594/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6658594/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTrauma 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGroup A has a shorter mean operative time (85.80 ± 3.47 minutes) compared to Group B (104.35 ± 2.92 minutes, p \u0026lt; 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 \u0026lt; 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 \u0026lt; 0.001). Group B achieved significantly higher clinical scores (28.20 ± 1.06) in contrast to Group A (23.80 ± 2.73, p \u0026lt; 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 \u0026lt; 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFixation 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eType of study/level of evidence\u003c/strong\u003e Therapeutic IV.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration number\u003c/strong\u003e: NCT06353048\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDate of registration\u003c/strong\u003e: 17 March 2024.\u003c/p\u003e\n\u003cp\u003eThe protocol and statistical analysis plan are available from the corresponding author upon reasonable request. Study plan is available at https://clinicaltrials.gov/study/NCT06353048\u003c/p\u003e","manuscriptTitle":"Short Term Radiological and Clinical Outcomes of Fixation of Schatzker II Tibial Plateau Fractures by Screws Only Versus Plate and Screws, A Comparative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-11 07:13:01","doi":"10.21203/rs.3.rs-6658594/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"87f37bc0-9c1d-4d81-a1ee-eaf4e08f89a4","owner":[],"postedDate":"August 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T07:54:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-11 07:13:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6658594","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6658594","identity":"rs-6658594","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}