[Reduction and fixation of tibia plateau fractures : Tips and tactics based on the 3-column concept]

The surgical management of tibial plateau fractures remains a challenge. The aim of surgery is the anatomical reconstruction of the joint surface with correct length, axis and rotation. The goal of osteosynthesis is to maintain a stable reduction to allow bone healing and functional aftercare. The continued advancements in 3D computed tomography has changed, the classification systems and, in parallel, the treatment strategies significantly changed. The 3‑column concept of Luo et al. has proven to be advantageous for planning of access, reduction and stabilisation.

Taking into consideration patient-specific factors. most displaced tibia plateau fractures are treated by surgery. However, no clear treatment recommendations exist in literature. In our clinical practice, joint displacement of more than 2 mm is generally not tolerated and surgical therapy is advised.

The surgical technique is preceded by the surgical strategy, which is based on the soft tissue situation and imaging results. The gold standard in imaging is computed tomography. Timing of surgery, patient positioning, surgical approaches as well as the implants are individually adapted to the fracture pattern.

The postoperative results are strongly influenced by fracture type, soft tissue condition, patient-specific factors, treatment method, and successful joint reconstruction. The functional postoperative results are often satisfactory even after complex tibia plateau fractures. In the literature, development of posttraumatic arthritis is reported to be 23-44%. In a study by Mehin et al. joint replacement of the knee was performed in 4.5% of cases following the surgical treatment of tibia plateau fractures.