4. SURGICAL OUTCOME OF CLOSED TIBIAL PLATEAU FRACTURE WITH POSTERIOR COLUMN DAMAGE USING PLATES AND SCREWS

Cao Thi1, Dang Van Dai2
1 University of Medicine and Pharmacy at Ho Chi Minh city
2 Tay Nguyen regional General Hospital

Main Article Content

Abstract

Objective: To evaluate the effectiveness of using screws and plates in the treatment of closed tibial plateau fractures with posterior column injury.


Methods: A case series, cross-sectional descriptive study was conducted on 45 patients with closed tibial plateau fractures involving posterior column damage from January 2019 to January 2020. Postoperative results were assessed at 3 months and 6 months, evaluating anatomical restoration and limb function using Rasmussen’s criteria.


Results: All patients achieved successful bone union, with no neurovascular complications and only 1 superficial infection. Rasmussen scores of anatomy and function indicated excellent or good outcomes in over 90% of cases, with significant functional improvements observed in knee joint range of motion and stability. Posterior column-specific approaches facilitated precise fracture reduction and fixation.


Conclusion: Implementing CT-based 3 column classification and tailored surgical approaches yield positive anatomical and functional outcomes in treating closed tibial plateau fractures with posterior column involvement. This approach should be considered to improve fracture management and patient recovery.

Article Details

References

[1] Pugalenthi P.V, Sivakumar R, Kumar T.C.P et al, Functional and radiological outcome of posterior column fracture fixation in tibial plateau fractures - a case series, J. Evolution Med. Dent. Sci., 2018, 7 (21): 2638-2643.
[2] Schatzker J, McBroom R, Bruce D, The tibial plateau fracture, The Toronto experience 1968-1975, Clin Orthop Relat Res., 1979, (138): 94-104.
[3] Yang G, Zhai Q, Zhu Y, Sun H, Putnis S, Luo C, The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system. Arch Orthop Trauma Surg., 2013, 133 (7): 929-934.
[4] Luo C.F, Sun H, Zhang B, Zeng B.F, Three-column fixation for complex tibial plateau fractures, J Orthop Trauma, 2010, 24 (11): 683-692.
[5] Hoekstra H, Kempenaers K, Nijs S, A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures, Eur J Trauma Emerg Surg., 2017, 43 (5): 637-643.
[6] El Gioushy A, Hegazy G, El Sherief A, Three-column Internal Fixation System for Comminuted Fracture of the Tibial Plateau, The Egyptian Journal of Hospital Medicine, 2019, 76 (2): 3425-3431.
[7] Zhu Y, Yang G, Luo CF et al, Computed tomography-based Three-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility, J Trauma Acute Care Surg., 2012, 73 (3): 731-737.
[8] Zhu Y, Meili S, Dong M.J et al, Pathoanatomy and incidence of the posterolateral fractures in bicondylar tibial plateau fractures: a clinical computed tomography-based measurement and the associated biomechanical model simulation, Arch Orthop Trauma Surg., 2014, 134 (10): 1369-1380.
[9] Chen H.W, Chen C.Q, Yi X.H, Posterior tibial plateau fracture: a new treatment-oriented classification and surgical management, Int J Clin Exp Med., 2015, 8 (1): 472-479, Published 2015 Jan 15.
[10] Orapiriyakul W, Apivatthakakul T, Phornphutkul C, Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study, Arch Orthop Trauma Surg., 2018, 138 (4): 505-513.
[11] Dias J.J, Stirling A.J, Finlay D.B, Gregg P.J, Computerised axial tomography for tibial plateau fractures, J Bone Joint Surg Br., 1987, 69 (1): 84-88.
[12] Tscherne H, Lobenhoffer P, Tibial plateau fractures. Management and expected results, Clin Orthop Relat Res., 1993, (292): 87-100.
[13. De La Caffinière J.Y, Fauroux L, Haas J.L, La fracture séparation-enfoncement postérieure dans les fractures bimalléolaires [Posterior depression-separation fracture in bimalleolar fractures], Rev Chir Orthop Reparatrice Appar Mot., 1990, 76 (8): 568-578.
[14] Meyers M.H, McKeever F.M, Fracture of the intercondylar eminence of the tibia, J Bone Joint Surg Am., 1970, 52 (8): 1677-1684.
[15] Barei D.P, Nork S.E, Mills W.J, Henley M.B, Benirschke S.K, Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique, J Orthop Trauma, 2004, 18 (10): 649-657.
[16] Van Den Berg J, Reul M, Nunes Cardozo M et al, Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures, Int Orthop, 2017, 41 (9): 1865-1873.
[17] Selvaraj V, Devadoss S, Jayakumar S, Gururagavendra P, Devadoss A, Column specific fixation for complex tibial plateau fractures - Midterm prospective study in South - Indian population, Injury, 2020, 51 (2): 497-504.
[18] Colman M, Wright A, Gruen G, Siska P, Pape H.C, Tarkin I, Prolonged operative time increases infection rate in tibial plateau fractures, Injury, 2013, 44 (2): 249-252.
[19] Rasmussen P.S, Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment, J Bone Joint Surg Am., 1973, 55 (7): 1331-1350.
[20] Chen H.W, Luo C.F, Extended anterolateral approach for treatment of posterolateral tibial plateau fractures improves operative procedure and patient prognosis, Int J Clin Exp Med., 2015, 8 (8): 13708-13715.
[21] Van Den Berg J, Nijs S, Hoekstra H, Limited value of the column concept in the operative management of posterior column tibial plateau fractures, Eur J Trauma Emerg Surg., 2020, 46 (5): 1143-1150.