Effects of preoperative planning on the treatment of the tibial plateau fractures using 3-column classification on radiological results

Abstract

Tibial plateau fractures are common and difficult to manage. The purpose of the treatment of tibia plateau fractures is to obtain a knee joint which is stable, painless and has functional range of motion. Schatzker’s classification and AO classification are most commonly used for the categorisation and to guide the treatment of these fractures. The 3-column classification is a useful tool in the preoperative surgical planning of tibial plateau fractures, especially in fractures extending to the posterolateral corner. The purpose of this study is to evaluate the effect of planning the treatment of the tibial plateau fractures using 3-column classification prior to surgical treatment on radiological results. A retrospective examination was made of 43 patients (32 males, 11 females, mean age 48.91) patients with operatively treated plateau fractures at Muğla Sıtkı Koçman University Medical Faculty was obtained. Preoperative and postoperative 6th month and 1st year radiological images were collected. Radiological evaluation of 43 patients included in the study revealed that 22 had a posterior column fracture. 11 of these posterior column fractures were fixated by posterior plate except medial and-or lateral plate or screw fixation. In addition, only interfragmanter screws were used in fixation of four patients and only plate oriented posterior screws were used in three patients with posterior column fracture. On the other hand, in four patients with posterior column fracture, no fixation was found except medial and-or lateral fixation for the posterior fractured components. The average preoperative modified rasmussen score of 22 patients with posterior column fracture was 3.5. Postoperative Modified Rasmussen Scores were calculated as 7.54 and 6.09 in the 6th months postoperative and 1st year, respectively. At the postoperative 1st year time nine patients in Kellgren-Lawrence grade 1, 18 patients in grade 2-3 and 16 the patients had grade 4 osteoarthritis. Grade 4 OA patients were all patients without any extra fixation for posterior column fracture. Modified Rasmussen Scores of these patients were also lower than other patients. Eleven patients who had fixation with posterior plate had higher radiological scores and less osteoarthritis findings. It was observed that there was no significant difference in terms of radiological scoring and osteoarthritic changes between patients who received an interragmenter screw and those who had a posterior oriented screw over the plate. As it is well known that postoperative negative changes and degeneration in the joint result from non-anatomic fixation. We think that in patients with proximal tibia fracture, diagnosis of fractures and recognition of fracture patterns in the posterior column are important and the most accurate diagnosis will be possible with CT imaging. We believe that efforts should be made for the anatomical detection of the fracture diagnosed.

Keywords

• 3-column classification,CT imaging,Osteoarthritis,Tibial plateau fractures

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