A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures

Hoekstra, Harm; Kempenaers, Kristof; Nijs, Stefaan

doi:10.1007/s00068-016-0696-z

Cited by 48 publications

(29 citation statements)

References 18 publications

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“…5,6 Subsequently, CT-based TCC has shown advantages in analyzing the fracture pattern and deciding on subsequent treatment. 7-10 Furthermore, other studies have proposed or analyzed the concepts of four-column classification, 11-13 ten-segment classification, 14 and fracture mapping 15 of TPFs, among others, all of which being based on CT images, in order to profoundly realize the characteristics of TPFs. However, these innovative classifications or mappings have, to date, been focused on the morphology of TPFs, but from different angles.…”

Section: Introductionmentioning

confidence: 99%

Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept

Zhang

Sun

Zhan

et al. 2019

Bone & Joint Research

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Objectives CT-based three-column classification (TCC) has been widely used in the treatment of tibial plateau fractures (TPFs). In its updated version (updated three-column concept, uTCC), a fracture morphology-based injury mechanism was proposed for effective treatment guidance. In this study, the injury mechanism of TPFs is further explained, and its inter- and intraobserver reliability is evaluated to perfect the uTCC. Methods The radiological images of 90 consecutive TPF patients were collected. A total of 47 men (52.2%) and 43 women (47.8%) with a mean age of 49.8 years (sd 12.4; 17 to 77) were enrolled in our study. Among them, 57 fractures were on the left side (63.3%) and 33 were on the right side (36.7%); no bilateral fracture existed. Four observers were chosen to classify or estimate independently these randomized cases according to the Schatzker classification, TCC, and injury mechanism. With two rounds of evaluation, the kappa values were calculated to estimate the inter- and intrareliability. Results The overall inter- and intraobserver agreements of the injury mechanism were substantial (κinter = 0.699, κintra = 0.749, respectively). The initial position and the force direction, which are two components of the injury mechanism, had substantial agreement for both inter-reliability or intrareliability. The inter- and intraobserver agreements were lower in high-energy fractures (Schatzker types IV to VI; κinter = 0.605, κintra = 0.721) compared with low-energy fractures (Schatzker types I to III; κinter = 0.81, κintra = 0.832). The inter- and intraobserver agreements were relatively higher in one-column fractures (κinter = 0.759, κintra = 0.801) compared with two-column and three-column fractures. Conclusion The complete theory of injury mechanism of TPFs was first put forward to make the TCC consummate. It demonstrates substantial inter- and intraobserver agreement generally. Furthermore, the injury mechanism can be promoted clinically. Cite this article: B-B. Zhang, H. Sun, Y. Zhan, Q-F. He, Y. Zhu, Y-K. Wang, C-F. Luo. Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept. Bone Joint Res 2019;8:357–366. DOI: 10.1302/2046-3758.88.BJR-2018-0331.R1.

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Section: Introductionmentioning

confidence: 99%

Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept

Zhang

Sun

Zhan

et al. 2019

Bone & Joint Research

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“…According to the revised three-column classification (rTCC), lateral tibial plateau fractures that extend into the posterolateral corner are defined as extended lateral column fractures and treated via a single lateral approach (Fig. 1) [1]. It's an improvement of Luo's three-column concept, who defined the posterior border of the lateral column anterior of the fibula head [2].…”

Section: Introductionmentioning

confidence: 99%

Extended lateral column tibial plateau fractures. How do we do it?

Hoekstra

Vanhees

Berg

et al. 2018

Injury

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We describe the operative management of extended lateral column fractures according to the revised three-column classification approach in a step-by-step fashion. We show that direct reduction and stable fixation of extended lateral column tibial plateau fractures via a limited arthrotomy and tibia condyle osteotomy, with the use of free subchondral 2.7 mm locking screws is a reliable technique. Subsequently, diverging VA-LCP locking screws further improve the structural properties. It is a straightforward technique and the single lateral approach (Lazy-S) facilitates direct reduction of the articular surface and stable fixation of the fracture fragments under direct vision with good radiological and fair functional outcome.

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“…Im Gegensatz zu den in die posterolaterale Ecke ausgedehnten lateralen Pfeilerfrakturen [15] sind isolierte Frakturen des posterolateralen Plateaus seltener [16] und deren adäquate osteosyn- thetische Fixierung von anterolateral kann schwierig oder unmöglich sein. Die posteriore abstützende Plattenosteosynthese hat sich als deutlich stabiler als die laterale Plattenosteosynthese erwiesen [17].…”

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Der kombinierte posteromediale und anterolaterale Zugang in der „floating“-Position zur operativen Versorgung der Zwei-Pfeiler-Tibiakopffraktur

Reul

Hoekstra

2017

Z Orthop Unfall

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The posterior tibial plateau is often affected in intra-articular tibial fractures. Moreover, treating these posterior fractures is recognised as an important prognostic factor. Open reduction and internal fixation of lateral and posterior two column tibial plateau fractures can be achieved via a combined reversed L-shape approach and an anterolateral approach in the floating position without intraoperative repositioning of the patient. The operative procedure starts in the posterior position with visualisation of the posterior column after lateral retraction of the medial head of the M. gastrocnemius. The posterior fragment is then reduced and fixated. This is followed by reversed patient tilt, and slight flexion and varus stress on the knee. An anterolateral approach is performed with visualisation of the lateral column, direct reduction and internal fixation of the lateral tibia plateau. Since June 2014, 14 two column tibial plateau fracture patients with posterior and lateral column involvement have been treated according to this technique. The median follow-up was 306 days (IQR 194 - 438); 1 patient was lost to follow-up. During the last outpatient visit, 7 patients reported pain to some extent. At a median of 110 days (IQR 96 - 181), 10 patients showed a full range of motion. One deep infection was noted postoperatively. At the 3 to 4 month postoperative CT control, 10 of 14 patients showed successful reduction with restored alignment, whereas in 8 of 14 patients there was a congruent articular surface without significant articular steps (< 2 mm). We have demonstrated that the surgical treatment of two column fractures of posterior and lateral tibial plateau fractures is technically possible via a combined posterior reversed L-shaped and anterolateral approach in a floating position without the necessity of intraoperatively repositioning of the patient. Although the number of patients was limited, the clinical and radiographic outcome was rather good.

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A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures

Cited by 48 publications

References 18 publications

Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept

Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept

Extended lateral column tibial plateau fractures. How do we do it?

Der kombinierte posteromediale und anterolaterale Zugang in der „floating“-Position zur operativen Versorgung der Zwei-Pfeiler-Tibiakopffraktur

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