Background/Objectives: Open reduction and internal fixation with plates and screws is the treatment of choice for bicondylar tibial plateau fractures. The use of a surgical approach remains a topic of debate regarding the site and number of incisions that ensure best access for reduction with minimum additional soft tissue damage. This retrospective cohort study compared clinical, radiological, and functional outcomes of single- (anterior) versus dual-incision (anterolateral and medial) approaches that are widely used in the operative treatment of Schatzker V–VI tibial plateau fractures. Methods: Eighty-two patients treated between 2005 and 2020 were retrospectively analyzed. Fifty-two underwent a single-incision (SI) approach and 30 a dual-incision (DI) approach. Operative parameters, complications, reduction quality, Knee Society Score (KSS), Oxford Knee Score (OKS), and post-traumatic arthritis incidence were assessed. Results: Mean patient age was 50.6 years, with a mean follow-up of 8.5 years. Operative time was shorter in the SI group, though fluoroscopy time was longer. No significant difference was observed in reduction quality or wound complications. Post-traumatic arthritis occurred in 57.6% of SI and 53.3% of DI patients, with severe arthritis more frequent in SI (30% vs. 12.5%, p < 0.05). Seven patients required conversion to total knee arthroplasty (five SI, two DI). Functional recovery was similar: mean KSS 68.6% (SI) vs. 70.5% (DI) and OKS 36.1 vs. 40.8 (p > 0.05) at 5 years. Conclusions: Both single- and dual-incision approaches for complex tibial plateau fractures provide satisfactory long-term outcomes. While differences in complications and arthritis rates were minor, surgical choice should be guided by the fracture morphology, patient characteristics, and surgeon’s experience to balance reduction quality with soft tissue preservation.

Septic tibial nonunion regarding proximal metaphysis is a rare complication with devastating results. Due to scarce literature about this condition, a prospective interventional study using Ilizarov External Frame was conducting with participants recruitment from December 2020 till January 2022. Primary outcomes were bone healing and infection eradication while side-effects were reported. Secondary outcomes were the final leg length discrepancy (LLD) more than 2.5 cm, external fixation time, the Association for the Advancement of Methods of Ilizarov (ASAMI) bone and functional classification scores, the Knee Outcome Survey-Activity of Daily Living Scale (KOS-ADSL) score, the American Academy of Orthopedic Surgeons (AAOS) Lower Limb Scale, the quality-adjusted life year (QALY) Time Trade-Off and the Short-Form 12 (SF-12) physical and mental score. 17 patients (16 males) with infected proximal tibial nonunions were treated with an Ilizarov external fixator at the Orthopedic Department of Serres General Hospital in Serres, Greece. Fracture healing and infection eradication were achieved in all patients with minimum follow-up of 30 months. Tibia deformity was present in four cases (23.5%), and length discrepancies were observed in one patient (3 cm). Limping was recorded in three patients. Stiffness of the knee or ankle was reported in six patients but all patients except one were pain-free. Everyone resumed their work or daily activities. According to ASAMI, the bone results were excellent in 13 patients, good in three patients, and fair in one. Analogously, the functional results were excellent in 11 patients, good in two and fair in 4 patients. Patient Reported Outcome Measures (PROMs) display an impressive improvement over the observation period. The Ilizarov method is a reliable technique for managing septic proximal tibial metaphyseal nonunions, particularly in cases involving extensive bone loss and existing deformities. Of vital importance is the assembling of an experienced multidisciplinary team to manage these rare and complex clinical conditions. ISRCTN30905788 (SePseT Ilizarov).