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

Complex proximal tibial plateau fractures are challenging injuries with substantial risk of malalignment, joint stiffness, and post-traumatic osteoarthritis. Column-based plating guided by computed tomography-based three-column concepts has been proposed to improve fixation, but the relative influence of fracture classification and plate configuration on outcome remains unclear.

In this prospective observational study, 57 adults (20-70 years) with complex proximal tibial plateau fractures treated with column-based plating at a single tertiary center (January 2023-January 2024) were evaluated. Fractures were classified by Schatzker (IV-VI) and Luo's three-column system (types 2 and 3). Patients underwent either single-plate or dual-plate fixation based on fracture morphology. Clinical and radiological outcomes were assessed at 1, 6, and 12 months using the modified Rasmussen clinical and radiological scores, International Knee Documentation Committee (IKDC) score, and Knee Society Score (KSS). Correlations of fracture classifications and plate number with these outcomes were analyzed.

The cohort included 37 males and 20 females; 40 fractures were right-sided. Schatzker types were IV (n = 6), V (n = 27), and VI (n = 24). Luo classification was type 2 (n = 29) and type 3 (n = 28). Dual-plate fixation was used in 38 patients (66.7%), and single-plate fixation in 19 (33.3%). At 1 year, modified Rasmussen clinical scores were excellent in 31 patients (54.4%) and good in 26 (45.6%). Radiologically, 19 patients (33.3%) had excellent, 31 (54.4%) good, and 7 (12.3%) fair results. Schatzker and Luo classifications showed strong and moderate negative correlations, respectively, with radiological scores at all-time points, but no significant correlation with clinical scores. Dual plating was associated with slightly higher mean radiological scores than single plating at 1, 6, and 12 months, while clinical scores (Rasmussen, IKDC, KSS) were similar between groups. Complications included one common peroneal nerve palsy requiring tendon transfer, and one superficial surgical site infection was observed.

In complex proximal tibial plateau fractures treated with column-based plating, fracture severity (Schatzker and Luo) strongly influences radiological outcomes but not short term functional recovery. Dual-plate fixation affords modestly superior radiological restoration compared with single-plate constructs, whereas functional scores at 1 year are comparable. Column-specific pre-operative planning and fixation can yield consistently good clinical outcomes even in high-grade fracture patterns.