Efficacy and biomechanical analysis of L-shaped plate treatment for osteoporotic Schatzker type II tibial plateau fractures

• Simple lateral L-shaped plate fixation achieves comparable clinical outcomes to double-plate fixation for osteoporotic Schatzker type II fractures involving the posterolateral tibial plateau, with significantly shorter operation time and less blood loss. • Finite element analysis shows that double-plate fixation (L-shaped plus T-shaped) provides superior biomechanical stability (lower displacement and stress) compared to single L-shaped plate, especially in osteoporotic bone. • The study introduces a novel comparison of osteoporotic versus non-osteoporotic models, quantifying the impact of bone quality on fixation stability, which is a significant advancement over previous non-osteoporotic focused research. • Clinical and biomechanical evidence suggests that routine addition of a posterior T-shaped plate may not be necessary for all cases, as the less invasive single L-shaped plate yields satisfactory results, but double-plate may be considered for high-risk patients.