Single versus dual incision approaches for dual plating of bicondylar tibial plateau fractures have comparable rates of deep infection and revision surgery

•346 AO/OTA 41-C bicondylar fractures were compared, 254 single pated with a single approach, 41 were dual-plated via a single anterior incision, and 51 dual plated with a dual incision technique.•There was no difference in rate of deep infection (22.0% vs 23.5%) or reoperation (31.7% vs 31.4%) between the two groups who had been dual plated through a single or dual incision.•Fractures able to be treated with a single implant (locking) through a single approach had significantly lower risk of infection of return to the OR. The use of one midline incision versus dual medial/lateral incisions for dual plating of bicondylar tibial plateau (BTP) fractures is controversial. This study aimed to compare rates of infection and secondary surgery in patients treated with dual plating for a BTP fracture using a single versus double incisions. Retrospective cohort study. Two Level-1 trauma centers. Patients > 18 years with a closed AO/OTA 41-C BTP fracture without compartment syndrome treated with a single midline or dual incision (lateral with medial or posteromedial) approach for dual plating. Dual plating through either a single anterior incision, or dual medial/lateral incisions. Rates of deep infection and reoperation were compared using Chi-square analysis (p-value of < 0.05). In total 636 AO/OTA 41-C BTP fractures treated between 1/1/01 and 12/31/18 were identified and assessed. After exclusions for limited follow up, other techniques, open fracture and the need for fasciotomies, 346 patients were studied. Of these 254 had been treated with a single plate / single approach technique while 92 had been dual plated, 41 through a single anterior incision while 51 had dual plating through separate lateral and medial or posteromedial incisions. For these 92 fractures, there was no significant difference in the rate of deep infection (22.0% vs 23.5%, s=0.858) or reoperation (31.7% vs 31.4%, p=0.973) between the single and dual incision groups. Injuries that had been treated with single plating via a single incision had comparably lower rates of deep infection (10.2% vs. 22.8%, p=0.003) and reoperation (12.2% vs. 31.5%, p