NEW CLASSIFICATION FOR PROXIMAL TIBIAL FRACTURES BY DR LUO

1. Three-Column Fixation for Complex
Tibial Plateau Fractures
Cong-Feng Luo, MD, PhD, Hui Sun, MD, Bo Zhang, MD, and Bing-Fang Zeng, MD
J Orthop Trauma Volume 24, Number 11, November 2010
DR. LOKESH SHAROFF
Orthopaedic Surgeon, Mumbai, India

2. 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 column-specific fixation
technique) for complex tibial plateau fractures (Schatzker
classification Types V and VI).

3. STUDY DESIGN
• PROSPECTIVE COHORT STUDY

4. 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.

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

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

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

8. THREE-COLUMN CONCEPT

9. 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 posterior–lateral 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

10. THREE COLUMN FRACTURE
• The ‘‘three-column fracture’’ is defined as at least one independent
articular fragment in each column.

11. 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.

12. 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)

13. POSTERIOR APPROACH

14. OPERATIVE TECHNIQUE

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

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

17. STASTICAL METHODS
-- SPSS 11.0
-- CORRELATION – BY PEARSON CORRELATION COEFFICIENT

18. RESULTS
-- 32 CASES
-- 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
-- TOTAL MEAN OPERATION TIME- 140
MINS
-- MEAN BLOOD LOSS – 327 ML
-- AVERAGE XRAY BONY TIME FOR
UNION- 13.1
--AVERAGE FULL WT BEARING TIME –
16.7 WEEKS

19. 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, 80–98), 90 (range, 84–98) and 87 (range, 80–95), 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)

26. 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.

27. THANK YOU