Bicondylar tibial plateau fractures pose a significant challenge for treating surgeons. If the articular surface of the medial plateau has a second split component in the posterior coronal plane, it is difficult to get direct visualization and ensure plate fixation when the patient is in the supine position. Using a technique in which a single preparation and draping of both legs is needed, patients were operated on using a healthy floating supine position maneuver through dual posteromedial and anterolateral incisions and triple plate fixations. By flexing and adducting the contralateral healthy hip over the injured leg, more lateral rotation of the fractured knee can be achieved, providing better access and visualization of the posterior medial plateau using a posteromedial gastrocnemius approach.

Surgeons should be wary of screws that appear close to the cortex on both radiographs, especially in the posterosuperior and anteroinferior quadrants, because such screws probably perforate the cortex. To minimize iatrogenic perforation, screw position should be assessed using a gradient figure of the RZs.

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