Online ISSN: 2515-8260

Keywords : Posterior column

A prospective study on Functional outcome of Column-specific Fixation of Complex Tibial Plateau Fractures

Dr D Hanuman Singh, Dr M. Anil Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 1722-1732

Introduction: Proximal tibia fractures are one of the commonest intra-articular fractures. Mechanism of injury usually is indirect coronal or direct axial compressive forces.Incidence of proximal tibial fractures is 1% of all fractures and 8% of the fractures in elderly. Most injuries affect lateral tibial condyle (55 to 70%) and isolated medial condyle fractures occur in 10 to 23% whereas the involvement of both condyle fractures is found in 10 to 30% of the reported series.Every different fracture type has its own characteristic morphology and response to the treatment. Apart from tibial plateau bony injury, meniscal tear and other ligament injuries of knee need to be assessed.
Material and Methods: This is a prospective study involving 60 patients with complex tibial condyle fractures with posterior column fractures. Preoperative computed tomography is taken with radiography for complete evaluation of fracture fragments even in the coronal plane. Fractures were classified as Schatzker type 4 or above with a posteromedial split depression. Plating is done with posteromedial locking compression for buttressing posteromedial fragment.
Result: Single-column fractures (Schatzker Type IV and Hohl and Moore Type I coronal split fracture), Two-column fracture (Schatzker type IV and type V), Three-column fractures (Schatzker Type V).  In our study majority of patients were Three-column fractures, followed by Two-column fracture and Single-column fractures.  Mean duration of surgery time of single column fractures were 65.41 minutes, two-column fracture 76.57 minutes and 94.91 minutes for Three-column fractures. After operative procedure, 18 (30.0%) patients got discharged on post op day-7, 12 (20%) patients on post op day-9, 10 (16.7%) on post op day-10 and 20 (33.3%) on post op day-12.
Conclusion: Based on our study we conclude that column specific fixation is a better option compared to conventional method of fixation as it provides better visualization, control over fragment, stable reduction and fixation of fragment. Even though radio-logical outcome is better in posterior column fixation group, functional outcome remains to be same in both the groups. It requires long term follow up and large number of patient study to assess the effectiveness of posterior column fixation.

To Study The Role Of CT Based Luo Classification For Surgical Management Of Proximal Tibia Fracture: Prospective Observational Study

Dr. Dhruv Gautam, Dr. Jashandeep Singh Chahal, Dr. Divanshu Goel, Dr. B. Lokesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2889-2895

Introduction: Proximal tibia fractures are one of the most common intrarticular fractures. Luo’s CT based 3 column concept helps to identify posterior column fractures which are missed on Schatzker’s plain radiograph-based classification and better understanding of fracture morphology.
Aim and Objective: To analyze the usefulness of CT based radiological assessment of tibial plateau fractures and fixation by 3 column concept.
Material and Method: This study has 25 patients with proximal tibia fractures who were enrolled in the study after due consent was taken. 3D CT scan was done in all cases along with plain x-rays. Fractures were analyzed as per Schatzker classification in addition to analysis on 3D CT. Fractures were surgically stabilized on 3 column concepts of Luo. All patients were evaluated for pain, knee ROM, walking capacity using Modified Rasmussen criteria and Visual Analogue scale. Follow up assessment of patients was done at regular interval of 6 weeks, 3 months and 6 months. The functional outcome of surgical intervention was evaluated after assessing patient’s subjective complaints, range of motion and stability of the knee joint using modified Rasmussen clinical criteria.
Result: In the present study of 25 cases, more than 65% cases were of complex Schatzker type of 4 to 6. Luo’s CT based 3 column concept helped to identify posterior column in 36% of cases. Luo classification helped better understand the pattern and morphology of fracture. The average time for union of fractures was 12.04±4.40 weeks. Fixation on basis of this concept and functional evaluation by Modified Rasmussen criteria showed the superiority of 3 column concept classification over Schatzker Classification