Functional outcome of column specific fixation in the management of complex tibial plateau fractures

Abstract

Introduction: Complex tibial plateau fractures usually have complicated intra-articular fracture pattern, often associated with severe soft tissue injury and high risk of wound complications. Single or dual column plating fixation principle based upon conventional x-ray for such fractures may not address multiplanar comminution that often has posterior shearing or coronal fractures. Computed tomography based evaluation of such fractures and column specific approach allow direct fracture visualization and anatomic reduction that results in satisfactory outcome.
 Objectives: To assess the clinical and functional outcome and complications of complex tibial plateau fractures fixed with column specific fixation principle.
 Methodology: This prospective study was carried out from September 2019 to August 2021 in Orthopaedic department of Nobel Medical College, Biratnagar. Consecutive sampling was used among patient with complex tibial plateau fractures meeting the inclusion criteria. Among 30 patients, with closed and Gustilo grade I or II Schatzker type V-VI fractures or AO type-C injuries to the proximal tibia were operated on column specific approach and followed up for clinico-radiological evaluation.
 Results: In this study, most of the patients belonged to 31-40 years of age group with mean age of 40.47 years. Majority of patients were male( 76.7%). Fracture was highly associated with road traffic accident which accounted for 83%. Fourteen patients underwent anteromedial and anterolateral plating(46.67%), 10 patients underwent anterolateral and posteromedial plating(33.33%) and remaining 6 patients underwent triple column plating(20%). The Rasmussen’s functional score at final follow up was 27.17±2.793(range 21-30). 86.7% patients had acceptable clinical outcome. The mean Rasmussen’s radiological score at final follow up was 8.97±1.217(range 6-10). Thus 93.4% patients had acceptable radiological outcome.
 Conclusion: Column specific approach addresses all the fracture fragments of complex tibial plateau fractures to achieve acceptable clinical and radiological outcome.

Fragment Specific Fixation for Tibial Plateau Fractures with particular reference to arthroscopic assisted surgery.

“…Rigid fracture fixation has benefits including early mobilisation, reduced soft tissue complications, better range of motion, and early mobilisation compared to other modes of fixation. These benefits are achieved through the accurate reduction of articular surfaces during posterior column fixation using an antiglide plate and medial and lateral column fixation using screws or lateral locking plates (20) .…”

“…(2020) (17) reported hardware incompatibility and infection risk (three cases between 123 cases) the biggest drawbacks of this method are the profound infection that has formed. Thanappan et al, (2019) (20) mentioned that In the course of the research, no participants had varus collapse. We found no evidence of delayed union or non-union, varus valgus deformity, implant fracture, or neurovascular damage.…”

Functional Outcome of Surgical Management of Trimalleolar Fractures

“…In all cases of trimalleolar fracture, regardless of size, anatomical reduction and preoccupation of the posterior malleolus is required to achieve a good clinical and functional outcome. The goal of management in trimalleolar fractures is to achieve good anatomic restoration of the articular surface, joint stability, axial alignment [1][2][3] , and early joint mobility. For the proper maintenance of the trimalleolar fracture interior fixation and the open reduction is required.…”