Keywords : three column classification
A prospective study on Functional outcome of Column-specific Fixation of Complex Tibial Plateau Fractures
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.