Functional and Radiological Outcomes of Surgical Management in Schatzker Type V and VI Tibial Plateau Fractures: A Prospective Observational Study

Background: Schatzker type V and VI tibial plateau fractures are high-energy injuries associated with complex articular disruption and significant soft-tissue compromise. Choosing the appropriate fixation method remains challenging, as it requires balancing anatomical joint restoration with soft-tissue preservation. This study evaluates the clinical, functional, and radiological outcomes of Open Reduction and Internal Fixation (ORIF) versus Ilizarov external fixation in the management of these fractures. Methods: A prospective observational study was conducted in the Department of Orthopaedics, SMS Medical College and Attached Hospitals, Jaipur, from January to December 2024. Fifty adult patients (>20 years) with radiologically confirmed Schatzker type V or VI tibial plateau fractures were treated surgically- 24 with ORIF plating and 26 with Ilizarov external fixation- using standardized postoperative rehabilitation. Outcomes were evaluated at 3 and 6 months using the Honkonen and J?rvinen (HJ) scoring system for subjective, clinical, functional, and radiological parameters. Knee flexion, weight-bearing progression, and postoperative complications were also documented and statistically analyzed. Results: Most patients were middle-aged males, and motorbike-related road-traffic accidents were the predominant injury mechanism. Functional mobility improved consistently in both fixation groups, with 84% of patients achieving good-to-excellent functional outcomes at 6 months. At final follow-up, knee flexion exceeded 110? in 84% of patients, and radiological outcomes were good in 86%. Complication rates were low in both groups; minor pin-tract infections occurred only in Ilizarov cases, while elective plate removal occurred in plating cases. Overall outcomes were comparable when fixation was selected according to fracture pattern and soft-tissue status. Conclusion: Both ORIF plating and Ilizarov external fixation are effective for managing Schatzker type V and VI tibial plateau fractures. A selective, patient-specific approach yields optimal results- ORIF is suitable for closed displaced fractures requiring precise anatomical reduction, whereas Ilizarov fixation is advantageous in open or soft-tissue-compromised injuries. Individualized fixation combined with early rehabilitation supports favourable functional and radiological recovery.