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Management of tibial plateau fractures with special reference to column classification


MOJ Orthopedics & Rheumatology
Raghul Dhakshanamoorthy,1 Yasir S Siddiqui,2 Mazhar Abbas,3 Mohd. Faizan,2 Julfiqar M,2 MJ Khan2

Abstract

Objective of the paper is to evaluate the outcome of the management of tibial plateau fractures with reference to Luo’s three column classification concept. The selection of surgical approach and appropriate fixation construct was dictated by the number of distinct articular fragments on CT scans and the concomitant soft tissue injury. The primary outcome measure was to evaluate the relationship between the number of column involved and fixation construct on secondary loss of reduction at healing. Secondary loss of reduction was defined as a change of alignment of ≥ 5 degrees into either varus or valgus at union. The secondary outcome measures were delayed union, non-union, peri-implant fracture and infection rates. Functional outcome were evaluated usingKnee Society Score.Forty-six patients were available for final follow up. Immediate postoperative mal-alignment was noted in 5 patients. For our primary outcome measure, we have one patient with secondary loss of reduction at final follow-up in double plating group. Secondary outcome measures showed non-union in 1 (2.17%), delayed union in 3 (6.52%), superficial infection in 3 (6.52%) and deep infection in 1 patient (2.17%). No peri-implant fracture was seen. The mean time for bone healing and full-weight bearing walk was 14.5 weeks.The mean range of motion of the affected knees was 2.39 to 131.27 at final follow-up of 12 months.In sight of the findings of our study along with existing literature Luo’s three column classification is an ideal classification in managing tibial plateau fractures as it dictates the appropriate fixation construct based on the number articular fragments. However it does not take into account the integrity of soft tissues, which is almost universal association with high velocity complex tibial plateau fractures. Hence, repercussions of use of fixation construct with multiple plates will unfold in future with long follow-up comparative studies addressing the bony as well as soft tissue complications.

Keywords

tibial plateau, column classification, fixation constructs, secondary loss of reduction, non-union, infection

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