Computed tomography-based three-column classification aid in complex tibial plateau fractures schatzkers type V and VI fixation

Abstract

Fractures of the tibial plateau usually result from high energy trauma. They change the knee kinematics, alter joint stability, and cause joint incongruity. These fractures range from simple lateral condyle fractures to severe comminuted metaphyseal fractures. Various surgical modalities like open reduction internal fixation with cannulated Screw fixation, Condylar plate with or without bone graft, AO/ASIF Buttress plate (T/L) with or without bone graft, Proximal tibial locking plate have been practiced. The aim of this Prospective Observational Cohort is to introduce a computed tomography-based ‘‘three-column fixation’’ concept; and evaluate the functional outcomes of treatment of internal fixation of tibial condylar fractures .35 patients of age group 18-70 yrs who presented with X-ray based Schatzker Type V and VI proximal tibia fractures were selected for the study and a three column CT-based classification was done. All the patients underwent Open Reduction and Internal Fixation with locking compression plating. The opted surgical approach depended on the assessment of injury by CT-based reconstruction of the fracture. The functional outcomes were assessed using oxford knee score. Complications were observed and treated accordingly with an average follow-up of 12 months. It was observed that the mean duration of the union was 14-16 weeks. Most of the patients (19) showed excellent results with a good range of motion of 122⁰. The combination of posterior and antero–lateral approaches is a safe and effective way to have direct reduction and satisfactory fixation for complex tibial plateau fractures. The three-column classification seems to be an efficient method to characterize and classify fractures of tibial plateau, particularly multiplanar fractures involving the posterior column.