Pre-operative use of CT based three-column concept for fragment specific fixation of proximal tibia fractures in a series of 84 cases

Abstract

Background: It is important to classify proximal tibia fractures based on CT scan in addition to plain radiograph. The 3-column concept was introduced to classify these fractures based on a transverse CT scan. This study aimed to evaluate the surgical and functional outcomes of fragment specific fixation in proximal tibia fractures using the 3-column concept. Materials and Methods: 84 cases of proximal tibia fractures (mean age: 42.85±11.94 years, range 23-72 years; 65 males and 19 females) were classified based on the 3-column concept (24 - 1 column, 50 – 2 column, 10 – 3 column). The surgical approach was decided for fragment-specific fixation based on the column involved. The clinic-functional assessment was done using fracture union time, range of motion, Oxford Knee Score and Functional Knee Society Score. Results: The mean follow up duration was 1.2-1.5 years. The average fracture union time was 15.63±1.98 weeks (range, 12-21 weeks). The mean flexion achieved at the final follow up was 132.74±4.49 degrees (range, 130-135 degrees). The mean follow-up Oxford Knee Score was 47.98±0.109 (range, 45-48) and the mean Functional Knee Society Score was 99.88±1.09 (range, 90-100) in all patients after 1 year. 2 patients showed they delayed wound healing with superficial infection and 1 patient had a stiff knee. There was no other complication. Conclusion: Using the CT-based three-column concept for fragment-specific fixation pre-operatively helps treat a complex proximal tibia fracture with acceptable complication rates and good functional outcomes.