A threecolumn internal fixation system with anatomical locking plates on tibial plateau is an effective and safe tool to treat complex threecolumn fractures of the tibial plateau and it is more convenient than the common plate. A combined prone and supine approaches for complex three. External fixation, orif or tka are the different appropriate procedures in complex bicondylar tibial plateau fractures schatzker v and vi, depending on the state of soft tissues, pattern of fracture, age, comorbidities, bone stock, patient compliance and severe preexisting oa. The combination of posterior and anteriorlateral approaches is a safe and effective way to have direct reduction and satisfactory fixation for such. Plain radiography often underestimates the severity of the injury. The morphological features of different schatzker types of. Conclusion the three column concept is a new and useful supplement to the present classification systems for tibial plateau fractures.
Updated three column fixation of tibial plateau fractures tpfs arouse the importance of posterior column articular reduction. A three column internal fixation system with anatomical locking plates on tibial plateau is an effective and safe tool to treat complex three column fractures of the tibial plateau and it is more convenient than the common plate. Consist of medial and lateral plateau medial larger medial lower concave medial bone harder thus less likely to fracture lateral higher convex lateral cartilage thicker 3. The risk of injury to the anterior tibial artery in the post. We presented a strategy of combined positions and approaches to treat these injuries. This study introduces an updated threecolumn concept for the classification and treatment of complex tibial plateau fractures. Tibia plateau fracture mapping and its influence on fracture. Department of orthopaedics, shanghai sixth peoples hospital, shanghai jiaotong university, shanghai 200233, china. Conclusion the threecolumn concept is a new and useful supplement to the present classification systems for tibial plateau fractures.
A revised 3column classification approach for the surgical planning of extended lateral tibial plateau fractures article pdf available in european journal of trauma and emergency surgery 435. Three column fixation seems to be an effective and a safe way for the treatment of multiplanar complex tibial plateau fractures. Pdf updated threecolumn concept in surgical treatment for. Threecolumn internal fixation for the treatment of complex. Tibial plateau fractures are complex injuries that require adequate imaging to assess prior to fixation. Fiftytwo consecutive patients with tibial plateau fractures were evaluated by five orthopaedic surgeons. Tibial plateau fractures requiring surgery are severe injuries of the lower extremity. Pdf a revised 3column classification approach for the. Tibial plateau fracture radiology reference article. Treatment of complex tibial plateau fractures with improved.
Updated threecolumn concept in surgical treatment for tibial. Jun 01, 2016 read whats new in the management of complex tibial plateau fractures. Complex tpfs with posterolateral pl articular injury is difficult to manage. Threecolumn fixation for complex tibial plateau fractures congfeng luo, md, jot journal of.
Objectiveto investigate the clinical results of three column internal fixation in the treatment of complex tibial plateau fractures by limited exposure and poking reduction. Prone and direct posterior approach for management of posterior. Sep 11, 20 a three column fixation technique to treat multiplanar complex tibial plateau fractures, based on a three dimensional understanding of the injuries, is recommended as a possible consequence of our research. Open reduction and internal fixation of the isolated tibial.
Three column fixation is a new fixation concept in treating complex tibial plateau fractures, especially useful for multiplanar fractures involving posterior column with excellent functional outcome. Threecolumn fixation is a new fixation concept in treating complex tibial plateau fractures, especially useful for multiplanar fractures involving. Computed tomographybased threecolumn classification in. Mar 15, 2016 three column fixation for complex proximal tibia fractures 1. Ct is very helpful in accurately defining the extent of the bony injury and facilitates orthopedic intervention. Purpose of this study was to assess the clinical outcome of stabilizing these biplanar medial tibial plateau fractures using dual plating technique through a single incision. Furthermore, the three column classification is clinically relevant and, to some degree, can. Surgical treatment of lateral tibial plateau fractures. Threecolumn fixation for complex tibial plateau fractures congfeng luo, md, phd, hui sun, md, bo zhang, md, and bingfang zeng, md j orthop trauma volume 24, number 11, november 2010 dr. We emphasize that this classification is most useful in high energy tibial plateau fractures. These fractures usually have associated softtissue lesions that will affect their treatment.
Wang y1, luo c 2, zhu y3, zhai q 4, zhan y5, qiu w 6, xu y7. F threecolumn fixation for complex tibial plateau fractures. Threecolumn fixation is a new fixation concept in treating complex tibial plateau fractures, which is especially useful for multiplanar fractures involving the posterior column. The application of a threecolumn internal fixation system. Tibial plateau fracture classifications are based on anteroposterior radiographs. Jul 18, 2017 the aim of the study was to evaluate the relation between demographic, injuryrelated, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome. The anterior tibial artery coursed through the interosseous membrane at 46. This study introduces an updated three column concept for the classification and treatment of complex tibial plateau fractures. The combination of posterior and anteriorlateral approaches is a safe and effective way to have direct reduction and satisfactory fixation for such difficult tibial plateau fractures. They principally affect young adults or the third age population. The full text of this article is available in pdf format. Unusual medial tibial plateau fracture fixation using dual.
The threecolumn fixation concept is becoming popular in orthopedic practice. Threecolumn classification for fracture of tibial plateau. Whats new in the management of complex tibial plateau fractures. Threecolumn classification and schatzker classification.
Oct 01, 2016 introductionthe treatment of tibial plateau fractures involving the lateral and posterolateral column is a demanding and fine surgical challenge. Analysis of functional outcome of columnspecific fixation of. Three column fixation for complex tibial plateau fractures congfeng luo, md, phd, hui sun, md, bo zhang, md, and bingfang zeng, md j orthop trauma volume 24, number 11, november 2010 dr. All consecutive adult patients with intraarticular tibial plateau fractures admitted in our urban academic medical centre between january 2005 and december 2009 were included in. Conclusion threecolumn fixation is a new fixation concept in treating complex tibial plateau fractures, which is especially useful for multiplanar fractures. Several approaches have been described by authors for reduction and fixation of posteromedial tibial plateau fractures and posteromedial approach was believed to be one of the best options for fixation of. Download citation threecolumn fixation for complex tibial plateau fractures 1 to introduce a computed tomographybased. Duration of incapacity of work after tibial plateau fracture. A combined preoperative assessment of fracture morphology and injury mechanism is utilized to determine surgical approach, implant placement and fixation sequence. Interobserver reliability assessment of the schatzker, ao. Posterior coronal plating of bicondylar tibial plateau. In this article, we report on the clinical results of using a threecolumn. All patients were classified into schatzker and three column classification systems using xrays and 2d and 3d ct images.
Aug 27, 2016 tibial plateau fractures are of great challenge to treat with open reduction and internal fixation, because fractures vary from simple to complex, with little or extensive articular involvement. Displaced posterolateral tibial plateau fractures require anatomic reduction and stabilization with a buttress plate. Jul 01, 2012 posterior coronal plating of bicondylar tibial plateau fractures through posteromedial and anterolateral approaches in a healthy floating supine position. Hence, recognition and comprehension of the fracture features will help orthopedic surgeons understand the injury mechanism better and manage these fractures by planning optimal surgical procedures. Tibial plateau fractures initial management guidelines. Three column fixation for complex proximal tibia fractures.
This study described the characteristics of geriatric tibial plateau fractures. Tibial plateau fractures orthopaedic trauma association. Preoperative plan with 3d printing in internal and external. The treatment of tibial plateau fractures in elderly patients is challenging, and the comprehension of epidemiology and morphology can be helpful. The purpose of this study was to evaluate the safety and clinical efficacy of combined approach for the treatment of lateral and posterolateral tibial plateau fractures. Column specific fixation for complex tibial plateau fractures injury. Complex tibial plateau fractures can be accompanied by varying degrees of soft tissue injury, and the method of fixation is important for effective control of postoperative complications. Schatzker classification system is one method of classifying tibial plateau fractures increase in type number denotes increasing severity, reflecting an increase in energy imparted to the bone at the time of injury and also an increasingly worse prognosis 1. Updated threecolumn concept in surgical treatment for.
Tibial plateau fractures are the most common intraarticular fractures, which require careful evaluation and preoperative planning. Schatzker classification of tibial plateau fractures. Three column fixation for complex tibial plateau frac tures. May 31, 2016 tibial plateau fractures are complex injuries produced by high or lowenergy trauma. Lateral condyle of tibial plateau fractures involving the posterolateral column belong to schatzker i, ii, and iii, or posterior or lateral column fractures in three. Treatment of complex tibial plateau fractures with improved three combined approaches. Department of orthopaedics, first affiliated hospital of nanjing medical university, nanjing 210029, chinahong gq, lyu tr, chen q, li x. Methodfrom september 2011 to february 2014,25 cases of complex tibial fractures were treated using three column reconstruction technique with limited exposure and poking reduction under fluoroscopic control. The aim of this study was to assess how the professional activity of patients will be affected after a tibial plateau fracture. Three column classification for fracture of tibial plateau and the related reliability assessment.
Conclusion the three column classification demonstrates a higher interobserver reliability and can be used as a supplement to the conventional schatzker classification, especially in the complex and posterior comminuted tibial plateau fractures. Updated threecolumn concept in surgical treatment for tibial plateau fractures a prospective cohort study of 287 patients. They reported a floating position, based on lateral decubitus with the lower leg rotated into a prone position when the posterior approach to. A combined approach, three column fixation, tibial plateau fracture access this article online. Threecolumn fixation for complex tibial plateau fractures. Three column fixation is a new fixation concept in treating complex tibial plateau fractures, which is especially useful for multiplanar fractures involving the posterior column. Clinical and radiographic predictors of acute compartment. A biomechanical study also shows that the mechanical strength of complex tibial plateau fractures can be obtained by either internal or external fixation 33.
The results of open reduction and internal fixation using direct posterior split gastrocnemius approach in two cases with isolated tibial lateral posterior plateau fractures which is a rare fracture are aimed at being shared in this study. Tibial plateau fractures have an impact not only on physically demanding jobs but notably on general professional life too. Posterolateral tibial plateau fracture is an unusual type of fracture. Appropriateness of fixation use in tibial plateau fractures. For those kinds of fractures, posterolateral with or without fibular osteotomy 1 3 and pron direct posterior 4 7 approaches have been described. Zhu yi, luo congfeng, yang guang, zhong biao, gao hong, zeng bingfang. Consist of medial and lateral plateau medial larger medial lower concave medial bone harder thus less likely to fracture lateral higher convex lateral cartilage thicker 3 vs. Three column fixation for complex proximal tibia clinical. Medial tibial plateau fractures is a subtype of proximal tibial fractures that involve the articular surface and can present in several distinct patterns. Diagnosis and treatment of tibial plateau fracture. Watson introduction fractures of the tibial plateau involve a major weightbearing joint covering a wide spectrum of injury, from minimally displaced intraarticular fractures to complex fractures that present with severe articular impaction, shaft extension, and softtissue. Precontoured locking plates are commonly used to treat such fractures.
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