Fixation of Posterior Column Injuries in Complex Tibial Plateau Fractures
Year: 2020
Type: article
Abstract: Introduction: This study is about consideration, and fixation of posterior column in tibial plateau fractures. A significant number of high velocity tibial plateau Fractures are having complex configuration and involves the posterior tibial plateau. A proper delineation of fracture morphology and fixation of posterior column in these complex injuries evolves into better radiological and functional outcome. We describe the approach and surgical technique for managing these injuries. Methods: Fifty-six patients with tibial plateau fractures were evaluated radiologically by conventional radiographs and computed tomography between August 2016 to July 2018 and among these 26 patients were found having involvement of posterior column which was managed either with posteromedial or Lobenhoffer approach depending upon the fracture configuration. The time of fracture union, maintenance of alignment, presence of complication and functional outcome assessment was done. Results: Twenty-two patients with posterior column involvement, were managed as per protocol and were followed up for a mean period of 16.5 months (range 13-25). Majority of our patients were male with the average age 38.3 years. Average time of surgical delay was 12.8 (range 7 to 18) days and radiological union was achieved at 18.8 weeks. Only 14 % patients had complication in term of superficial wound infection or wound dehiscence. None of the patients had varus collapse. At one-year follow-up, about 12 patients showed excellent and 9 patients had good functional outcome on Rasmussen knee score. Discussion: The goal of treating tibial plateau fracture is anatomical reduction, maintain alignment and stable fixation to allow early rehabilitation and improved functional outcome. Failure to recognize coronal fractures like posteromedial fragment in the past lead to failure of reduction, varus collapse and poor outcome. Increased awareness about coronal fragments, use of computed tomography including 3 D reconstruction to delineate the fracture configuration and stabilization of posterolateral and posteromedial fragment has increased the functional results. Conclusion: Improved understanding of fracture pattern in terms of three column concept with computed tomography and better exposure of posterior column injuries has facilitated proper reduction and stable fixation and better functional outcome in these complex injuries.
Authors: Vikas Saxena, Pavan Pradhan, RaviChandulal Makadia
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4398775813