Tibial plateau fractures constitute approximately 1% of all fractures and represent complex intra-articular injuries that significantly disrupt knee congruity and load transmission mechanisms.[1] These injuries are frequently caused by high-energy trauma in younger populations or low-energy mechanisms in osteoporotic elderly individuals, presenting a dual challenge for orthopedic management.[2] The primary objective in treating these fractures is to achieve anatomic reduction, restore axial alignment, and maintain stable fixation to prevent secondary displacement and subsequent post-traumatic osteoarthritis (PTOA).[3] Despite advancements in surgical techniques, PTOA remains a prevalent long-term complication, with population-level data indicating an elevated risk of total knee arthroplasty following surgically treated tibial plateau fractures.[4] Historical classification systems, such as the Schatzker and AO/OTA frameworks, have guided treatment strategies but often fail to adequately address posterior column involvement, which is under-recognized on standard two-dimensional radiographs.[5] The introduction of the three-column concept by Luo et al. has revolutionized the understanding of these fractures by emphasizing the medial, lateral, and posterior columns, thereby highlighting the necessity of computed tomography (CT)-based evaluation for comprehensive surgical planning.[6] Posterior column fragments, including posteromedial and posterolateral shear components, are critical for maintaining the flexion-extension envelope and preventing posterior sag, yet they remain difficult to reduce and fixate using traditional approaches.[7] Failure to directly stabilize these posterior components can lead to persistent instability, altered joint mechanics, and accelerated degenerative changes.[8] Open reduction and internal fixation (ORIF) is considered the gold standard for managing displaced tibial plateau fractures, aiming to restore articular congruity and provide sufficient stability for early mobilization.[9] However, the correlation between precise radiographic reduction and long-term functional outcomes remains a subject of ongoing investigation, with some studies suggesting that factors beyond articular step-off, such as soft-tissue integrity and meniscal preservation, significantly influence patient-reported outcomes.[10] Recent evidence indicates that while function improves over the first five years following ORIF, many patients continue to experience pain, stiffness, and limitations in high-demand activities.[11] Infection has been identified as the greatest risk factor for poor patient-reported outcomes, underscoring the importance of meticulous soft-tissue management and staged protocols in high-energy injuries.[12] The specific goal of this study is to evaluate the mid- to long-term functional outcomes of patients who have undergone ORIF for tibial plateau fractures involving the posterior column. We hypothesize that anatomic restoration of the posterior column with stable buttress fixation will be associated with lower rates of PTOA, greater range of motion, and superior patient-reported function. The primary objectives are to investigate the incidence of PTOA and its impact on joint function and quality of life, evaluate the range of motion and functional status at mid- to long-term follow-up, and assess pain levels during daily and recreational activities. Secondary objectives include identifying fracture characteristics, surgical techniques, and patient demographics that influence functional outcomes and complication rates, thereby addressing the current deficiency in literature regarding the specific long-term sequelae of posterior column involvement.

Study Design: This was an ambispective observational study conducted to evaluate the mid- to long-term functional and radiological outcomes of tibial plateau fractures involving the posterior column treated by open reduction and internal fixation (ORIF). The study included both retrospective review of institutional trauma registry records and prospective follow-up of enrolled patients. Study Area: The study was carried out in the tertiary hospital. Data were obtained from the institutional trauma registry, inpatient records, operative notes, and follow-up outpatient evaluations. Study Population: The study population comprised skeletally mature patients who underwent ORIF with plating for tibial plateau fractures involving the posterior column. Fracture diagnosis was confirmed by standard radiographs and computed tomography (CT) scans. Sample Size: The required sample size was calculated using a single-proportion formula based on the reported prevalence of proximal tibial plateau fractures of approximately 1% in adults.[1] n = (Z² × p × (1 − p)) / d² Where: Z = 1.96 at 95% confidence interval p = 0.01 d = 0.03 The calculated sample size was 42.26, which was rounded to 42 participants. Inclusion Criteria: • Patients aged 18–65 years • Acute tibial plateau fractures involving the posterior column confirmed on radiological imaging (CT and/or standard radiographs) • AO/Orthopedic Trauma Association (AO/OTA) classification 41-B or 41-C fractures • Patients treated primarily with ORIF using plate fixation • Availability for regular follow-up evaluations • Willingness to provide written informed consent Exclusion Criteria: • Polytrauma patients requiring emergency surgical interventions affecting study outcomes • Open fractures with major soft tissue loss requiring staged fixation or flap coverage • Pre-existing lower limb functional impairment such as severe osteoarthritis, peripheral neuropathy, or rheumatoid arthritis • Previous surgery involving the affected knee • Patients unwilling or unable to provide written informed consent Sampling Methodology: A purposive sampling technique was used. Eligible patients were identified from a prospectively maintained institutional database, operative logs, and ward records. Patients fulfilling the inclusion criteria were screened and enrolled consecutively. Data Collection and Procedure: • After obtaining written informed consent, demographic details, injury mechanism, fracture classification, and perioperative variables were recorded using a predesigned proforma. • Clinical examination included assessment of knee range of motion (ROM), wound healing status, and complications. • Fracture patterns were classified according to the AO/OTA classification system using standard radiographs and CT scans. • All patients underwent ORIF with plate fixation. The implant used was proximal tibial locking compression plate (LCP) selected according to fracture morphology and surgeon preference. • Standard perioperative protocols including intravenous antibiotic prophylaxis, thromboprophylaxis, and wound care were followed as per institutional guidelines. • Postoperative rehabilitation, including early knee mobilization and progressive weight-bearing, was individualized based on fracture stability and soft tissue healing. • Follow-up assessments were conducted during the immediate postoperative period, at 3 months, 6 months, and 12 months postoperatively. Outcome Measures: Primary Functional Outcome: Functional outcome was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), a validated patient-reported outcome measure.[13] The questionnaire assessed five domains: pain, symptoms, activities of daily living, sports/recreation, and knee-related quality of life. Radiological Outcome: Radiographic evaluation was performed using standard anteroposterior and lateral knee radiographs immediately postoperatively and at 12 months follow-up. Osteoarthritic changes were graded using the Kellgren–Lawrence (K–L) grading system (Grades 0–4).[14] CT scans were additionally used during the perioperative period to evaluate fracture morphology and reduction quality. Additional Variables: Additional variables recorded included age, sex, side involved, mechanism of injury, time to surgery, implant configuration, postoperative complications, reoperations, and unplanned readmissions. Data Management: All data were entered into a password-protected Microsoft Excel database with de-identified patient records to maintain confidentiality. Data validation measures were applied to minimize entry errors. Statistical Analysis: Data were analyzed using Stata MP version 17 (StataCorp LLC, College Station, Texas, USA). Continuous variables were summarized as mean ± standard deviation (SD). Categorical variables were presented as frequency and percentage (%). Associations between categorical variables were analyzed using the Chi-square test. Comparisons of continuous variables between AO fracture groups were performed using the independent samples Student’s t-test. Changes in functional outcome scores (KOOS domains) across follow-up intervals were assessed using the paired samples Student’s t-test. A p-value < 0.05 was considered statistically significant. Ethical Considerations: The study protocol was approved by the Institutional Ethics Committee. All procedures were conducted in accordance with the Declaration of Helsinki (1975, revised 2000). Written informed consent was obtained from all participants before enrollment. Patient confidentiality was maintained by anonymization of all clinical and radiological records

A total of 42 patients were included in the study. Age-wise distribution showed that 11 patients (26.2%) were in the 18–30 years age group, 12 patients (28.6%) were in the 31–40 years age group, 11 patients (26.2%) were in the 41–50 years age group, and 8 patients (19.0%) were aged ≥51 years. Sex distribution revealed that 32 patients (76.2%) were male and 10 patients (23.8%) were female. Regarding educational status, 14 patients (33.3%) had secondary education, 12 patients (28.6%) were graduates, 8 patients (19.0%) had primary education, 5 patients (11.9%) had higher secondary education, and 3 patients (7.1%) were illiterate. Socioeconomic status distribution showed that 14 patients (33.3%) belonged to the upper-lower class, 9 patients (21.4%) to the lower class, 8 patients (19.0%) to the lower-middle class, 7 patients (16.7%) to the upper class, and 4 patients (9.5%) to the upper-middle class. Occupational distribution demonstrated that 18 patients (42.9%) were engaged in service, while farmers, homemakers, and manual laborers accounted for 8 patients (19.0%) each. The distribution of injury characteristics and operative profile was comparable between AO 41-B and AO 41-C fracture groups (Table 1). On Chi-square analysis, the mechanism of injury showed no significant association with fracture classification (χ² = 5.83, p = 0.442). Similarly, implant type distribution did not differ significantly between the two groups (χ² = 0.248, p = 0.883), and the time to surgery was also comparable (χ² = 0.988, p = 0.610). On independent samples Student’s t-test, operative time (t = 0.426, p = 0.672), intraoperative blood loss (t = 0.354, p = 0.725), and duration of hospital stay (t = −1.493, p = 0.143) were not significantly different between AO 41-B and AO 41-C fracture patterns. The distribution of implant type according to surgical approach showed a complete correspondence between the chosen surgical approach and the fixation method (Figure 1). The anterolateral approach was exclusively associated with lateral locking plate fixation, the dual approach was exclusively associated with dual plating, and the posteromedial approach was exclusively associated with posteromedial buttress plating. This association was analyzed using the Chi-square test and was found to be statistically significant (χ² = 84.0, df = 4, p < 0.001). Postoperative radiological assessment demonstrated satisfactory fracture reduction and alignment across the study cohort. The majority of patients achieved acceptable articular reduction within the predefined threshold, with only a small proportion showing residual incongruity (Figure 2). The association between AO fracture classification and achievement of acceptable articular step-off was evaluated using the Chi-square test, which showed no statistically significant difference between fracture groups (χ² = 0.079, df = 1, p = 0.779). Overall, radiological parameters of step-off, tibial slope difference, and condylar widening remained within acceptable postoperative limits (Figure 3). The frequency of postoperative complications was low across the study cohort (Table 2). In the early postoperative period, surgical site infection was the most commonly observed complication, while no cases of deep infection were recorded. Isolated cases of thromboembolic events and wound dehiscence were also noted. In the late postoperative period, symptomatic hardware was the most frequent complication, followed by arthrofibrosis, whereas implant failure and reoperation were infrequent. Overall, the majority of patients remained free from both early and late postoperative complications throughout follow-up. Serial assessment of KOOS domains demonstrated progressive improvement across all follow-up intervals (Table 3). On paired samples Student’s t-test, significant improvements were observed in pain, activities of daily living, quality of life, and sports/recreation scores at 3, 6, and 12 months compared with the immediate postoperative baseline. The magnitude of improvement increased consistently over time in all domains, with corresponding t-test analysis showing statistically significant differences at each follow-up interval. These findings indicate a steady functional recovery and enhancement in patient-reported outcomes throughout the one-year follow-up period. At 12 months follow-up, functional, radiological, and patient-reported outcomes were available for most patients, although there was some loss to follow-up, resulting in variation in sample size across outcome measures (Table 4). Functional assessment demonstrated satisfactory knee range of motion, with the majority of patients achieving full knee extension and only a small proportion showing residual extension lag. Radiological evaluation using the K–L grading system showed that most patients had absent or mild osteoarthritic changes, while higher-grade osteoarthritis was observed in only a few cases. Patient-reported quality-of-life assessment showed moderate recovery overall, although a substantial proportion of patients continued to have quality of life scores below the predefined threshold at one year. TABLES AND TABLE LEGENDS: Table 1: Injury Characteristics and Operative Profile According to AO Fracture Classification. Chi-square test for categorical variables and independent samples Student’s t-test for continuous variables. Variable Category / Parameter AO 41-B (n=17) AO 41-C (n=25) Total (n=42) Statistical Test p-value Mechanism of injury Fall from height 0 (0.0%) 2 (8.0%) 2 (4.8%) χ² = 5.83 0.442 Fall from stairs 6 (35.3%) 5 (20.0%) 11 (26.2%) Road traffic accident 6 (35.3%) 7 (28.0%) 13 (31.0%) Slip in bathroom 2 (11.8%) 7 (28.0%) 9 (21.4%) Slip in courtyard 1 (5.9%) 0 (0.0%) 1 (2.4%) Sports-related injury 2 (11.8%) 3 (12.0%) 5 (11.9%) Twisting injury 0 (0.0%) 1 (4.0%) 1 (2.4%) Implant type Dual plating 7 (41.2%) 10 (40.0%) 17 (40.5%) χ² = 0.248 0.883 Lateral locking plate 5 (29.4%) 6 (24.0%) 11 (26.2%) Posteromedial buttress 5 (29.4%) 9 (36.0%) 14 (33.3%) Time to surgery (days) Day 1 3 (17.6%) 4 (16.0%) 7 (16.7%) χ² = 0.988 0.610 Day 2 13 (76.5%) 17 (68.0%) 30 (71.4%) Day 3 1 (5.9%) 4 (16.0%) 5 (11.9%) Operative parameters Operative time (minutes) 89.65 ± 20.86 86.72 ± 22.48 — t = 0.426 0.672 Blood loss (ml) 247.53 ± 68.67 239.72 ± 71.11 — t = 0.354 0.725 Hospital stay (days) 5.29 ± 1.21 5.96 ± 1.54 — t = -1.493 0.143 Table 2: Frequency Distribution of Early and Late Postoperative Complications Complication Category Complication Yes No Early postoperative (n=42) Surgical site infection (SSI) 2 (4.8%) 40 (95.2%) Deep infection 0 (0.0%) 42 (100.0%) DVT/PE 1 (2.4%) 41 (97.6%) Wound dehiscence 1 (2.4%) 41 (97.6%) Late postoperative (n=42) Implant failure 1 (2.4%) 41 (97.6%) Symptomatic hardware 6 (14.3%) 36 (85.7%) Arthrofibrosis 4 (9.5%) 38 (90.5%) Reoperation 1 (2.4%) 41 (97.6%) DVT, deep vein thrombosis; PE, pulmonary embolism. Table 3: Paired Analysis of KOOS Domain Scores Over Time. Paired samples Student’s t-test was used. KOOS Domain Comparison Postoperative Mean ± SD Follow-up Mean ± SD Mean Difference t-value df p-value Pain Postop vs 3 months 55.9 ± 6.78 66.0 ± 6.75 −10.1 −6.57 41 <0.001 Postop vs 6 months 55.9 ± 6.78 73.9 ± 6.91 −17.9 −14.10 41 <0.001 Postop vs 12 months 55.9 ± 6.78 81.2 ± 5.29 −25.3 −19.29 41 <0.001 Activities of Daily Living Postop vs 3 months 53.1 ± 7.08 64.0 ± 7.25 −10.9 −8.61 41 <0.001 Postop vs 6 months 53.1 ± 7.08 72.5 ± 7.60 −19.5 −12.54 41 <0.001 Postop vs 12 months 53.1 ± 7.08 79.8 ± 6.97 −26.8 −19.42 41 <0.001 Quality of Life Postop vs 3 months 45.9 ± 7.58 55.0 ± 5.89 −9.10 −5.88 41 <0.001 Postop vs 6 months 45.9 ± 7.58 62.5 ± 7.34 −16.56 −10.30 41 <0.001 Postop vs 12 months* 46.0 ± 7.72 68.3 ± 7.66 −22.28 −13.73 39 <0.001 Sports/ Recreation Postop vs 3 months 42.2 ± 8.66 54.9 ± 8.59 −12.7 −49.9 41 <0.001 Postop vs 6 months 42.2 ± 8.66 62.0 ± 8.49 −19.9 −56.7 41 <0.001 Postop vs 12 months 42.2 ± 8.66 71.6 ± 9.06 −29.4 −72.4 41 <0.001 Table 4: Functional, Radiological, and Patient-Reported Outcomes at 12 Months Outcome Domain Parameter (n) Mean ± SD/Count (%) Knee Range of Motion ROM flexion (n=40) 120.78 ± 9.22 ROM extension lag (n=38) 0.94 ± 2.83 Knee Extension Status Full extension achieved (n=38) 34 (89.5%) Full extension not achieved (n=38) 4 (10.5%) K-L Osteoarthritis Grade Grade 0 (n=38) 20 (52.6%) Grade 1 (n=38) 12 (31.6%) Grade 2 (n=38) 5 (13.2%) Grade 3 (n=38) 1 (2.6%) KOOS Quality of Life KOOS QOL score (n=40) 68.3 ± 7.66 KOOS QOL <75 (n=38) 31 (81.6%) KOOS QOL ≥75 (n=38) 7 (18.4%) ROM, Range of Motion; QOL, Quality of Life. Sample size varied according to the availability of clinical, radiological, and patient-reported follow-up data at 12 months. ACKNOWLEDGEMENT The authors sincerely thank all the patients who participated in this study. We also acknowledge the support of the Department of Orthopedics, the operating room staff, and the medical records personnel for their assistance with patient care, data collection, and follow-up. Their cooperation and contributions were invaluable to the successful completion of this study.

The present study demonstrates that ORIF of tibial plateau fractures involving the posterior column yields consistently favorable mid-term radiological and functional outcomes when guided by a column-specific fixation strategy. Our findings substantiate the hypothesis that anatomical restoration of articular congruity, tibial slope, and condylar width, achieved through morphology-driven surgical planning, translates into meaningful, progressive improvements in patient-reported function over a 12-month period. This is evidenced by statistically significant gains across all domains of KOOS, with pain and activities of daily living showing robust early recovery, while quality of life and sports/recreation improved more gradually. These results align closely with the trajectory described by Gonzalez et al.,[11] who reported continued functional improvement over five years post-ORIF, and with Van den Berg et al.,[15] who emphasized the negative impact of posterior column involvement on outcomes, a factor our standardized approach appears to mitigate effectively. A key contribution of this work is the demonstration that AO/OTA 41-B and 41-C fracture classifications do not inherently dictate differential resource utilization or radiological outcomes when posterior column anatomy is prioritized in surgical decision-making. The absence of significant differences in operative time, blood loss, hospital stay, or achievement of acceptable articular step-off between these groups challenges the notion that complete articular (C-type) fractures are invariably more complex to manage. This supports the paradigm shift toward three-dimensional, CT-based morphological assessment over traditional two-dimensional classification systems like Schatzker or AO for guiding fixation strategies.[16] Our data corroborate recent evidence from Kingery et al.,[17] who found that posterior column involvement in lateral split-depression fractures leads to worse outcomes, underscoring the necessity of dedicated posterior fixation, a principle our protocol explicitly addresses through approach-specific plating (anterolateral, posteromedial, or dual). The low complication profile observed, characterized by infrequent superficial infections, no deep infections, and rare implant failure, is consistent with contemporary series by Kugelman et al., employing staged or early definitive fixation following appropriate soft tissue management.[18] The predominance of symptomatic hardware as a late complication mirrors findings of Garner et al.,[19] suggesting that routine implant removal may be a consideration for select patients, though our study was not designed to evaluate this intervention. Radiologically, the high prevalence of K-L grade 0–1 osteoarthritis at one year indicates that precise reduction effectively delays degenerative progression, a finding that resonates with Singleton et al.,[20] who established a direct link between articular incongruity and long-term osteoarthritis risk . However, a critical observation is the persistent gap between objective recovery and subjective well-being: despite excellent radiological alignment and satisfactory knee motion (with 89.5% achieving full extension), 81.6% of patients reported KOOS quality of life scores below 75 at 12 months. This structure-symptom discordance is well-documented in the literature, including by Bormann et al.,[21] and highlights that structural healing does not equate to full psychosocial and functional restoration. This phenomenon likely reflects the multifactorial nature of quality of life, which is influenced by occupational demands, fear of re-injury, and residual limitations in high-demand activities, factors not fully captured by KOOS alone. This study has several limitations inherent to its ambispective design. Retrospective data collection may have introduced information bias, particularly in the documentation of early complications. The modest sample size (n=42) limited our ability to conduct robust subgroup analyses comparing specific approaches (e.g., posteromedial vs. dual plating) or implant types. Furthermore, the 12-month follow-up horizon, while sufficient to capture early functional recovery, is inadequate to assess the long-term development of post-traumatic osteoarthritis or late functional decline, which often manifests beyond two years. The single-center nature of the study and the use of individualized rehabilitation protocols also constrain generalizability, as outcomes may vary with different postoperative care regimens. In the context of existing evidence, this study adds granular detail on the efficacy of a posterior column-focused ORIF protocol in a South Asian cohort, demonstrating that such an approach can achieve outcomes comparable to those reported in Western populations.[22,23] It reinforces the clinical imperative of preoperative CT for identifying posterior fragment morphology and selecting the appropriate surgical exposure. For patient care, these findings advocate for early definitive fixation once soft tissue conditions permit, coupled with structured rehabilitation to maximize range of motion and minimize arthrofibrosis. From a health policy perspective, the data support the standardization of imaging protocols and surgeon training in posterior column management to improve outcome consistency. Future research should prioritize larger, prospective, multicenter studies with extended follow-up (>5 years) to identify predictors of long-term joint survival and to refine rehabilitation protocols that address the lingering deficit in patient-perceived quality of life.

This ambispective observational study demonstrates that column-specific open reduction and internal fixation for posterior column tibial plateau fractures provides satisfactory radiological restoration, low complication rates, and significant improvement in functional outcomes during the first postoperative year. Comparable outcomes between AO/Orthopedic Trauma Association 41-B and 41-C fractures suggest that fracture morphology and a column-specific fixation strategy may be more important than fracture classification alone. Despite favorable clinical and radiological recovery, knee-related quality of life remained suboptimal in many patients, highlighting the need for continued rehabilitation and longer-term follow-up. Further large, prospective multicenter studies are needed to validate these findings and evaluate long-term outcomes.

1. Akhade N, Chopade R, Shere P, Shahare P. Functional outcome of proximal tibia intra-articular fractures after open reduction and internal fixation. Int J Res Orthop. 2023;9(2):300–3. 2. Pathanaboina R, Naz S. A study of functional outcome in three-column fixation of complex tibial plateau fractures. Int J Adv Res (Indore). 2024;12(04):1020–4. 3. Ganeshsankar Kandasamy Associate Professor K, Ganeshsankar Kandasamy K, Sundaram Kandasamy M, Shankar R. A study on functional outcome of osteosynthesis for fracture proximal tibia. International Journal of Orthopaedics Sciences. 2020;6(4):693–7. 4. Kraml N, Haslhofer DJ, Winkler PW, Stiftinger JM, Heidecke S, Kwasny O, et al. Tibial plateau fractures are associated with poor functional outcomes and a low conversion rate to total knee arthroplasty. Knee surgery, sports traumatology, arthroscopy . 2024;32(5):1308–16. 5. O’neill D, Thorne TJ, Scolaro J, Haller JM. Evaluation and Management of Posterior Tibial Plateau Fractures. Journal of the American Academy of Orthopaedic Surgeons . 2024;32(19):e970–81. 6. 6. Kumar S, Karthikeyan N, Shankar SS. Analysis Of The Functional And Radiological Outcome Of Tibial Plateau Fractures Treated By Open Reduction Internal Fixation With Locking Compression Plate Based On 3D CT Three Column Four Segment Specific Fixation: A Prospective Study. Res J Pharm Biol Chem Sci. 2024;15(1):464–8. 7. Manikandan N, Saravanakumar KP. A study on functional and radiological outcome of complex tibial plateau fractures by posteromedial plating. Int J Res Orthop. 2019;5(2):223–6. 8. Saodekar H, Agrawal K. Fixation of Posterior Tibial Plateau Fracture and Its Outcome: A Comparative Study. Int J Med Biomed Stud. 2020;4(1):231–4. 9. Strafford M, Biddle M, Rooney B. The requirement for total knee arthroplasty following surgical fixation of tibial plateau fractures. Bone Jt Open. 2025;6(12):1575–80. 10. Madi S, Chotta S, Fadel PA, Fares MY, Zeichen J. Association between articular surface depression and functional outcomes after ORIF of tibial plateau fractures: a retrospective cohort study. European Journal of Trauma and Emergency Surgery. 2025;51(357). 11. Gonzalez LJ, Hildebrandt K, Carlock K, Egol KA, Konda SR. Patient function continues to improve over the first five years following tibial plateau fracture managed by open reduction and internal fixation. Bone Joint J. 2020;102-B(5):632–7. 12. O’Neill DC, Sato EH, Steffenson LN, Froerer DL, Higgins TF, Rothberg DL, et al. Patient-reported outcomes after tibial plateau fracture: infection confers greatest risk of poor outcome. European journal of orthopaedic surgery & traumatology . 2024;35(1):34. 13. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64. 14. Kellgren JH, Lawrence JS. Radiological Assessment of Osteo-Arthrosis. Ann Rheum Dis. 1957;16(4):494. 15. van den Berg J, Reul M, Nunes Cardozo M, Starovoyt A, Geusens E, Nijs S, et al. Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures. Int Orthop. 2017;41(9):1865–73. 16. Chandhar C M, T Pradeepkumar, Rao K, I P, a S, Kumar R S, et al. Functional and Radiological Outcome in Tibial Plateau Fracture Following Column-Specific Fixation. Indian J Appl Res. 2023;13(9):58–61. 17. Kingery MT, Deemer AR, Lamba S, Anil U, Ganta A, Egol KA, et al. Posterior Column Involvement in AO/OTA 41B3 Lateral Split-Depression Tibial Plateau Fractures Leads to Worse Outcomes. Journal of Knee Surgery. 2026; 18. Kugelman D, Qatu A, Haglin J, Leucht P, Konda S, Egol K. Complications and unplanned outcomes following operative treatment of tibial plateau fractures. Injury. 2017;48(10):2221–9. 19. Garner MR, Thacher RR, Ni A, Berkes MB, Lorich DG. Elective removal of implants after open reduction and internal fixation of Tibial Plateau fractures improves clinical outcomes. Arch Orthop Trauma Surg. 2015;135(11):1491–6. 20. Singleton N, Sahakian V, Muir D. Outcome After Tibial Plateau Fracture: How Important Is Restoration of Articular Congruity? J Orthop Trauma. 2017;31(3):158–63. 21. Bormann M, Bitschi D, Neidlein C, Berthold DP, Jörgens M, Pätzold R, et al. Mismatch between Clinical–Functional and Radiological Outcome in Tibial Plateau Fractures: A Retrospective Study. J Clin Med. 2023;12(17):5583. 22. Van Dreumel RLM, Van Wunnik BPW, Janssen L, Simons PCG, Janzing HMJ. Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures. Injury. 2015;46(8):1608–12. 23. Biz C, Maso G, Gambato M, Belluzzi E, Pozzuoli A, Favero M, et al. Challenging Surgical Treatment of Displaced Articular Tibial Plateau Fractures: Do Early Knee Radiographic Features Have a Predictive Value of the Mid‐Term Clinical Functional Outcomes? Orthop Surg. 2019;11(6):1149.