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Limited value of the column concept in the operative management of posterior column tibial plateau fractures

  • Juriaan van den Berg
  • Stefaan Nijs
  • Harm HoekstraEmail author
Original Article
  • 45 Downloads

Abstract

Introduction

The three-column concept has been proposed as tool in surgical decision-making for treating tibial plateau fractures. Recent studies have underscored the negative effect of posterior column tibial plateau fractures on clinical outcome. The purpose of this study was to assess the value of the three-column concept and posterior plating in posterior column fractures. We hypothesized that treating patients according to the three-column concept improves functional outcome.

Methods

111 consecutive tibial plateau fractures, treated between January 2009 and December 2016, with at least a posterior column fracture were included. Relevant demographic and treatment variables were studied. Applied treatment was retrospectively evaluated according to the three-column concept. Patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS).

Results

Median follow-up was 43.1 months (IQR 29.0–63.3) with a response rate of 80.2%. Outcome scores were markedly lower compared to the general population. 22.5% patients were treated according to the three-column concept and 27% was treated with posterior plating. Predominantly combined fractures of posterior and lateral columns were treated without fixation of the posterior column. Neither treatment according to the three-column concept and/or with posterior plating was found to significantly influence outcome.

Conclusions

The outcome of posterior column fractures was equal, regardless of whether these fractures were treated or not. This indicates that the three-column concept seems insufficient and gives rise to further debate on surgical strategies of posterior column fractures. The implementation of trauma mechanism-based fracture morphology in the three-column concept might be important to consummate the three-column concept as guiding tool.

Level of evidence

3.

Keywords

Three-column concept Tibial plateau fractures Posterior column Functional outcome 

Abbreviations

PCF

Posterior column fracture

TCC

Three-column concept

ORIF

Open reduction and internal fixation

KOOS

Knee injury and osteoarthritis outcome score

Notes

Funding

There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was completed in compliance with national legislation and the guidelines of the ethics committee of the University Hospitals Leuven.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Molenaars RJ, Mellema JJ, Doornberg JN, Kloen P. Tibial plateau fracture characteristics: computed tomography mapping of lateral, medial, and bicondylar fractures. J Bone Joint Surg Am. 2015;97:1512–20.  https://doi.org/10.2106/JBJS.N.00866.CrossRefGoogle Scholar
  2. 2.
    Yang G, Zhai Q, Zhu Y, et al. The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system. Arch Orthop Trauma Surg. 2013;133:929–34.  https://doi.org/10.1007/s00402-013-1735-4.CrossRefGoogle Scholar
  3. 3.
    Wang Y, Luo C, Zhu Y, et al. Updated Three-Column Concept in surgical treatment for tibial plateau fractures—a prospective cohort study of 287 patients. Injury. 2016;47:1488–96.  https://doi.org/10.1016/j.injury.2016.04.026.CrossRefGoogle Scholar
  4. 4.
    Jiwanlal A, Jeray KJ. Outcome of posterior tibial plateau fixation. J Knee Surg. 2016;29:34–9.  https://doi.org/10.1055/s-0035-1564729.CrossRefGoogle Scholar
  5. 5.
    van den Berg J, Reul M, Nunes Cardozo M, et al. Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures. Int Orthop. 2017;41:1865–73.  https://doi.org/10.1007/s00264-017-3566-3.CrossRefGoogle Scholar
  6. 6.
    Ahmad R, Patel A, Mandalia V, Toms A. Posterior tibial slope: effect on, and interaction with, knee kinematics. JBJS Rev. 2016;4:e3–3.  https://doi.org/10.2106/JBJS.RVW.O.00057.CrossRefGoogle Scholar
  7. 7.
    Hoekstra H, Kempenaers K, Nijs S. A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures. Eur J Trauma Emerg Surg. 2017;43:637–43.  https://doi.org/10.1007/s00068-016-0696-z.CrossRefGoogle Scholar
  8. 8.
    Metsemakers WJ, Morgenstern M, McNally MA, et al (2017) Fracture-related infection: a consensus on definition from an international expert group. Injury 6–11.  https://doi.org/10.1016/j.injury.2017.08.040.
  9. 9.
    Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64.  https://doi.org/10.1186/1477-7525-1-64.CrossRefGoogle Scholar
  10. 10.
    de Groot IB, Favejee MM, Reijman M, et al. The Dutch version of the Knee Injury and Osteoarthritis Outcome Score: a validation study. Health Qual Life Outcomes. 2008;6:16.  https://doi.org/10.1186/1477-7525-6-16.CrossRefGoogle Scholar
  11. 11.
    Hoekstra H, Vanhees J, van den Berg J, Nijs S. (2018). Extended lateral column tibial plateau fractures. How do we do it? Injury.  https://doi.org/10.1016/j.injury.2018.07.027.Google Scholar
  12. 12.
    Chang SM, Hu SJ, Du SC, et al. Four-quadrant/column classification of tibial plateau fractures. Int Orthop. 2018;42:725–7.  https://doi.org/10.1007/s00264-017-3733-6.CrossRefGoogle Scholar
  13. 13.
    Orapiriyakul W, Apivatthakakul T, Phornphutkul C. Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study. Arch Orthop Trauma Surg. 2018;138:505–13.  https://doi.org/10.1007/s00402-018-2875-3.CrossRefGoogle Scholar
  14. 14.
    Millar SC, Arnold JB, Thewlis D, et al. A systematic literature review of tibial plateau fractures: what classifications are used and how reliable and useful are they? Injury. 2018;49:473–90.  https://doi.org/10.1016/j.injury.2018.01.025.CrossRefGoogle Scholar
  15. 15.
    Krause M, Preiss A, Muller G, et al. Intra-articular tibial plateau fracture characteristics according to the “Ten segment classification. Injury. 2016;47:2551–7.  https://doi.org/10.1016/j.injury.2016.09.014.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Trauma SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  2. 2.Department of Development and RegenerationKU Leuven-University of LeuvenLeuvenBelgium

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