Treatment of high-energy fractures of the tibial plateau requires an inordinate degree of surgical effort in order to avoid complications. Fracture reduction can be a challenge to experienced hands and the soft tissue conditions are intolerant of careless dissection. In general, it is an oversimplification to use one technique of stabilisation for such a heterogenous group (even within one classification tier). This article describes the specific attributes of Schatzker type 6 injuries (AO 41C) that enable decision making algorithms to be generated and balances the merits for plate stabilisation and external fixation against injury characteristics. A detailed description is given for circular fixation in these injuries to assist those unfamiliar with the technique.
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