Three-Column Fixation for Complex

Tibial Plateau Fractures

Cong-Feng Luo, MD, PhD, Hui Sun, MD, Bo Zhang, MD, and BingFang Zeng, MD
J Orthop Trauma Volume 24, Number 11, November 2010

DR. LOKESH SHAROFF

Orthopaedic Surgeon, Mumbai, India

JOT JOURNAL OF ORTHOPAEDIC

TRAUMA
Objectives:
1) To introduce a computed tomography-based three
column fixation concept; and
2) to evaluate clinical outcomes (by using a columnspecific fixation technique) for complex tibial plateau
fractures (Schatzker classification Types V and VI).

STUDY DESIGN
PROSPECTIVE COHORT STUDY

PATIENTS
From December 2004 to July 2006, 266 cases of tibial
plateau fractures were operated.
32 cases diagnosed as three-column fractures,
3 patients - excluded because they could not be
contacted during follow-up.
So, 29 cases included for the study.

SURGICAL TEAM
All patients were operated by 2 surgeons belonging to 1
surgical team.

EXTERNAL FIXATOR
It was applied in patients,
- who required pre operative reduction,
- high energy injury to the soft tissues.

INVESTIGATIONS
- XRAYS,
- CT- SCANS -- WERE PERFORMED AFTER EX-FIX as it
gave more information.

THREE-COLUMN CONCEPT

1 COLUMN
-- 1 COLUMN is 1 independent articular depression with break
of the column is defined as a fracture of the relative column.
-- Pure articular depression (S-type 3) was defined as a Zero
Column Fracture.
-- anterolateral fracture and a separate posteriorlateral
articular depression with a break of the posterior wall, the
fracture is defined as a two-column (lateral and posterior
column) fracture.
-- Antero-Medial + Postero-medial = 2 column

THREE COLUMN FRACTURE

The three-column fracture is defined as at least one
independent articular fragment in each column.

POST OPERATIVE PROTOCOL

-- AP & LATERAL XRAYS were done immediate post- op , every
6 weeks till union and then 2 years after the index operation.
-- TPA, FTA, MEDIAL AND LATERAL POSTERIOR SLOPE ANGLE
MEASURED
MALREDUCTION intra-articular step-off 2 mm,
TPA > 95*OR < 80, PA > 15 OR <-5
SECONDARY LOSS OF REDUCTION- > 5* MALALIGNMENT OR
2MM ARTICULAR DEPRESSION
SF-36 FORM FILLED AT 2 YRS.

OPERATIVE TECHNIQUE
-- Floating position- prone and lateral position
- prone posterior, postero medial and antero-medial
columns
3.5 mm plates were used (lcdcp, t-plate, cloverleaf plate)

POSTERIOR APPROACH

OPERATIVE TECHNIQUE

OPERATIVE TECHNIQUE
-- ANTERO-LATERAL APPROCH LATERAL COLUMN
FIXATION SUB-MENISCAL APPROACH
-- L-PLATE or LISS PLATE applied

POST-OPERATIVE PROTOCOL
--CPM 3 DAYS
--PARTIAL WEIGHT BEARING- BEGIN FROM 4TH-6TH WEEK
-- FULL WEIGHT BEARING AFTER BONY UNION

STASTICAL METHODS
-- SPSS 11.0
-- CORRELATION BY PEARSON CORRELATION
COEFFICIENT

RESULTS
-- 32 CASES
-- TOTAL MEAN OPERATION
TIME- 140 MINS
-- 3 CASES LOST TO FOLLOW UP
-- 23 MEN AND 6 WOMEN
-- AVERAGE AGE 46.8
-- 13 LEFT , 16 RIGHT
ALL WERE CLOSED FRACTURES
WITH NO DNVD

-- MEAN BLOOD LOSS 327

ML
-- AVERAGE XRAY BONY TIME
FOR UNION- 13.1
--AVERAGE FULL WT BEARING
TIME 16.7 WEEKS

RESULTS
1 case 2* varus and valgus deformity each, 2 cases had screw
loosening
2 cases had wound drainage with negative bacterial culture
Patient scores for the Short Form 36, Hospital for Special
Surgery score, and lower-extremity measure at 24 months
postoperatively were 89 (range, 8098), 90 (range, 8498) and
87 (range, 8095), respectively.
Average ROM of the affected knees was 2.7 to 123.4.
NO significant differences in either TPA or PA on the
radiographs immediately postoperatively and 24 months
postoperatively
(P = 0.840 for TPA, 0.060 for medial posterior-slope-angle and
0.061 for lateral posterior-slope-angle)

CONCLUSION
The three-column concept is a new and useful
supplement to the present classification systems for
tibial plateau fractures.
Three-column fixation seems to be an effective and a
safe way for the treatment of multiplanar complex tibial
plateau fractures.

THANK YOU