Publication:

Study of functional outcome in proximal tibia fracture fixation using three column concept

Background Proximal tibia fractures are complex intra-articular injuries often resulting from high-energy trauma. Traditional classification systems like Schatzker and AO/OTA rely on anteroposterior radiographs and may overlook posterior column injuries. The Three-column classification, introduced by Luo et al, utilizes computed tomography (CT) to address multiplanar fractures, particularly those involving the posterior column.

Methods A prospective study was conducted on 80 patients with closed tibial plateau fractures at a tertiary care centre from January 2021 to January 2022. Fractures were classified using the Three-column concept. All patients underwent Open reduction and internal fixation (ORIF) using column-specific approaches. Functional outcomes were assessed after a minimum follow-up of 6 months using the modified Rasmussen clinical score.

Results The mean age was 37.88±8.79 years, with a male preponderance (86.2%). Road traffic accidents were the most common mode of injury (88.7%). Two-column fractures were the most frequent (46.2%), followed by three-column fractures (32.5%). Functional outcomes were excellent in 17.5%, good in 68.7%, fair in 11.3%, and poor in 2.5% of cases. The mean Rasmussen score was significantly higher for one-column medial fractures (28±0) compared to two-column (24.05±1.54) and three-column fractures (24.80±1.35). Complications included superficial infection (11.3%), knee stiffness (8.7%) and screw pull-out (7.5%).

Conclusions The Three-column concept provides a comprehensive understanding of fracture morphology, facilitating precise surgical planning for complex multiplanar injuries. Fixation based on this concept yields satisfactory functional outcomes, although multi-column injuries inherently carry a prognosis of lower functional scores compared to isolated column fractures.