Three-column Plating for Complex Tibial Plateau Fractures: Multivariate Predictors of Superior Functional Recovery

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomedical engineering

Background:

• Complex proximal tibial plateau fractures pose significant challenges, risking malalignment, joint stiffness, and post-traumatic osteoarthritis.
• Column-based plating using three-column concepts is a proposed fixation method, but its effectiveness relative to fracture classification and plate configuration is unclear.

Purpose of the Study:

• To evaluate the influence of fracture classification and plate configuration on clinical and radiological outcomes in complex proximal tibial plateau fractures treated with column-based plating.

Main Methods:

• Prospective observational study of 57 adult patients with Schatzker IV-VI and Luo type 2/3 proximal tibial plateau fractures.
• Treatment involved column-based plating (single or dual).
• Outcomes assessed at 1, 6, and 12 months using modified Rasmussen, IKDC, and KSS scores; correlations with fracture classification and plate number were analyzed.

Main Results:

• Schatzker and Luo classifications correlated negatively with radiological outcomes but not clinical outcomes.
• Dual-plate fixation showed slightly higher mean radiological scores than single-plate fixation at all time points.
• Clinical outcomes (Rasmussen, IKDC, KSS) were comparable between single and dual plating groups at 1 year.

Conclusions:

• Fracture severity significantly impacts radiological outcomes in complex proximal tibial plateau fractures treated with column-based plating.
• Dual-plate fixation provides modest radiological benefits, while functional outcomes are similar to single-plate fixation at one year.
• Column-specific planning and fixation can achieve good clinical results even in severe fractures.