A Prospective Study Comparing the Functional Outcomes of Complex Tibial Plateau Fractures Using Computed
Rajiv Munde1, Santosh Borkar1, Abhinav Prabhu1
1Department of Orthopaedics, Maharashtra Institute of Medical Education and Research Medical College, Pune, Maharashtra, India.
Introduction:
Tibial plateau fractures are complex intra-articular injuries that require precise classification for optimal management. The widely used Schatzker classification, based on X-rays, provides a two-dimensional assessment, while the computed tomography (CT)-based three-column theory offers a more detailed three-dimensional analysis. This study aimed to compare the functional outcomes of complex tibial plateau fractures classified using these two systems and treated with locking compression plates (LCP).
Materials And Methods:
A prospective, observational study was conducted involving 44 patients with closed Schatzker type V and VI tibial plateau fractures. Patients were allocated into two groups: Group A (n = 22) based on CT-based three-column classification and Group B (n = 22) based on X-ray-based Schatzker classification. All patients underwent open reduction and internal fixation using anatomical LCPs. Functional outcomes were assessed using the Rasmussen clinical score at regular follow-ups. Intraoperative variables and post-operative complications were also analyzed.
Results:
Group A showed significantly better Rasmussen scores at 6, 12, 24, and 36 weeks (P < 0.05), along with shorter operative time, reduced blood loss, lower radiation exposure, and fewer complications compared to Group B. Joint stiffness and post-traumatic arthritis were notably higher in the Schatzker group.
Conclusion:
CT-based three-column classification enables more accurate surgical planning and leads to superior functional and perioperative outcomes in complex tibial plateau fractures compared to the Schatzker classification.
