Effects of preoperative planning on the treatment of the tibial plateau fractures using 3-column classification on radiological results

Year 2020, Volume: 37 Issue: 3, 81 - 85, 30.04.2020

Emre Gültaç , Hıdır Tanyıldızı , Cem Yalın Kılınç , Hüseyin Aydoğmuş Rabia Kılınç , Nevres Aydoğan

Abstract

Tibial plateau fractures are common and difficult to manage. The purpose of the treatment of tibia plateau fractures is to obtain a knee joint which is stable, painless and has functional range of motion. Schatzker’s classification and AO classification are most commonly used for the categorisation and to guide the treatment of these fractures. The 3-column classification is a useful tool in the preoperative surgical planning of tibial plateau fractures, especially in fractures extending to the posterolateral corner. The purpose of this study is to evaluate the effect of planning the treatment of the tibial plateau fractures using 3-column classification prior to surgical treatment on radiological results. A retrospective examination was made of 43 patients (32 males, 11 females, mean age 48.91) patients with operatively treated plateau fractures at Muğla Sıtkı Koçman University Medical Faculty was obtained. Preoperative and postoperative 6th month and 1st year radiological images were collected. Radiological evaluation of 43 patients included in the study revealed that 22 had a posterior column fracture. 11 of these posterior column fractures were fixated by posterior plate except medial and-or lateral plate or screw fixation. In addition, only interfragmanter screws were used in fixation of four patients and only plate oriented posterior screws were used in three patients with posterior column fracture. On the other hand, in four patients with posterior column fracture, no fixation was found except medial and-or lateral fixation for the posterior fractured components. The average preoperative modified rasmussen score of 22 patients with posterior column fracture was 3.5. Postoperative Modified Rasmussen Scores were calculated as 7.54 and 6.09 in the 6th months postoperative and 1st year, respectively. At the postoperative 1st year time nine patients in Kellgren-Lawrence grade 1, 18 patients in grade 2-3 and 16 the patients had grade 4 osteoarthritis. Grade 4 OA patients were all patients without any extra fixation for posterior column fracture. Modified Rasmussen Scores of these patients were also lower than other patients. Eleven patients who had fixation with posterior plate had higher radiological scores and less osteoarthritis findings. It was observed that there was no significant difference in terms of radiological scoring and osteoarthritic changes between patients who received an interragmenter screw and those who had a posterior oriented screw over the plate. As it is well known that postoperative negative changes and degeneration in the joint result from non-anatomic fixation. We think that in patients with proximal tibia fracture, diagnosis of fractures and recognition of fracture patterns in the posterior column are important and the most accurate diagnosis will be possible with CT imaging. We believe that efforts should be made for the anatomical detection of the fracture diagnosed.

Keywords

3-column classification, CT imaging, Osteoarthritis, Tibial plateau fractures

Supporting Institution

none

Project Number

none

References

• Referans1. Cole PLB, Schatzker J, Watson JT. Tibial plateau fractures; 2009;p. 2201–87.
• Referans2. Honkonen SE (1995) Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 9:273–277.
• Referans3. Lansinger O, Bergman B, Korner L et al (1986) Tibial condylar fractures. A twenty-year follow-up. J Bone Joint Surg Am 68:13–19.
• Referans4. Mahadeva D, Costa ML, Gaffey A. Open reduction and internal fixation versus hybrid fixation for bicondylare/severe tibial plateau fractures: a systematic review of the literature. Arch Orthop Trauma Surg. 2008;128:1169–1175.
• Referans5. Biggi F et al (2010) Tibial plateau fractures: internal fixation with locking plates and the MIPO technique. Injury 41(11):1178–1182.
• Referans6. Wang H et al (2013) An improved reduction technique for depression fractures of lateral tibial plateau. Chinese J Reparative and Reconstr Surg 27(1):12–16.
• Referans7. Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma. 1987;1:97–119.
• Referans8. Katsenis D, Vasilis A, Panayiotis M, et al. Minimal internal fixation augmented by small wire transfixion frames for high-energy tibial plateau fractures. J Orthop Trauma. 2005;19:241–248.
• Referans9. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indicator for surgical treatment. J Bone Joint Surg Am 1973;55(7):1331—50.
• Referans10. Schatzker J, McBroom R, Bruce D. Tibial plateau fractures. The toronto experience 1968—1975. Clin Orthop 1979;138:94—104.
• Referans11. Hoekstra, H., Kempenaers, K., & Nijs, S. (2017). A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures. European Journal of Trauma and Emergency Surgery, 43(5), 637-643.
• Referans12. Piątkowski, K., Kwiatkowski, K., Piekarczyk, P., Zegadło, A., & Rojkowski, R. (2015). Comparative Analysis of Clinical Outcomes of Tibial Plateau Fractures and Computed Tomography Examinations. Ortopedia, traumatologia, rehabilitacja, 17(2), 135-145.
• Referans13. Luo C-F, Sun H, Zhang B, Zeng B-F. Three-column fixation for complex tibial plateau fractures.JOrthop Trauma. 2010;24(11):683–92. doi:10.1097/BOT.0b013e3181d436f3.
• Referans14. Giannoudis PV, Tzioupis C, Papathanassopoulos A, Obakponovwe O, Roberts C. Articular step-off and risk of post-traumatic osteoarthritis. Evidence today. Injury 2010; 41(10): 986-95.
• Referans15. Volpin G, Dowd GS, Stein H, Bentley G. Degenerative arthritis after intra- articular fractures of the knee. J Bone Joint Surg Br 1990;72:634–8.
• Referans16. Lizaur-Utrilla A et al (2015) Total knee arthroplasty for osteoarthritis secondary to fracture of the tibial plateau. A prospective matched cohort study. J 30(8):1328–1332 Arthroplasty.
• Referans17. Wang Y, Luo C, Zhu Y, Zhai Q, Zhan Y, Qiu W, et al. Updated Three-Column Concept in surgical treatment for tibial plateau fractures - A prospective cohort study of 287 patients. Injury. 2016;47(7):1488-96.
• Referans18. Zhu, Y., Yang, G., Luo, C. F., Smith, W. R., Hu, C. F., Gao, H., ... & Zeng, B. F. (2012). Computed tomography-based Three-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility. Journal of Trauma and Acute Care Surgery, 73(3), 731-737.
• Referans19. Gicquel T, Najihi N, Vendeuvre T, Teyssedou S, Gayet LE, Huten D. Tibial plateau fractures: reproducibility of three classifications (Schatzker, AO, Duparc) and a revised Duparc classification. Orthop Traumatol Surg Res. 2013;99(7):805-16.
• Referans20. Eggli S, Hartel MJ, Kohl S, Haupt U, Exadaktylos AK, Roder C. Unstable bicondylar tibial plateau fractures: a clinical investigation. J Orthop Trauma. 2008;22(10):673-79.
• Referans21. Marsh JL, Buckwalter J, Gelberman R et al (2002) Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am 84-A:1259–1271.