Surgical management by Open Reduction and Internal Fixation with column specific plating of Complex Tibial Plateau Fractures—Three Column Fixation: A Prospective study analysis

Abstract

Background:To treat the multiplanar complex tibial plateau fractures, in recent years, “three-column fixation” technique is used, which is based on the three-dimensional understanding of the fractures of CT rapidly. Most current classification systems for tibial plateau fractures are based on two-dimensional images of x-ray, that directing surgeons to pay attention to medial and lateral fixation without fixing posterior column fixation. After careful review and application of the 3DCT scan for the evaluation of upper tibialplatue fractures, importance of posterior fixation, especially for the posteromedial fragment is being realised. Material and methods: Type of study: Prospective. Place of study: Department of Orthopedics, Osmania General Hospital. Sample size and inclusion criteria: 20 patients with displaced tibial plateau fractures with posterior column involvement. Duration of study: 2 ½ years (June 2018 to December 2020). Material: Proximal tibial locking plates, T/L buttress plates, posteromedial and posterior tibial locking plate, 6.5 and 4mm cancellous screws (locking, non- locking), 4.5, 4.9 mm cortical screws (locking, non-locking). Position of patient during surgery: Both supine and prone Approach: Posteromedial (Loben Hoffer), posterolateral (mod. Frosch), Antero lateral. Results: Rasmussen’s Clinical and Radiological Criteria were utilized for evaluation of patients. 30% - excellent, 50% -good 10%-fair,10% poor. Conclusion: Three-column fixation concept in treating complex tibial plateau fractures, is especially useful for multiplanar fractures involving posterior column with excellent functional outcome.