CT based management of high energy tibial plateau fractures: A retrospective review of 53 cases

Abstract

Objectives: The management of high energy tibial plateau fractures is a surgical challenge. Recently described Luo's classification is based on CT scans and is more objective with a better inter-observer agreement as compare to Schatzker and AO/OTA classifications. We describe the functional results of a series of 53 cases classified and managed according to the Luo's column concept.

Methods: A retrospective review of 53 high energy tibial plateau fractures, operated between January 2012 and March 2015 at a Level I trauma center, was performed. CT scans were used to classify these injuries based on the number of columns involved. Plating configuration and surgical approach were chosen based on the number of independent articular fragments on axial sections at the level of fibular head.

Results: 1 one-column, 51 two-column and 1 three-column fractures were studied. Triple plating was done in 5 patients. Mean follow-up was 2.7 years and mean Insall Knee score was 95.42. Four patients had varus malalignment and 1 had joint depression in the post-operative period. These were due to imperfect reduction during the surgery itself, and no case of late collapse was detected.

Conclusion: Utilizing Luo's classification for treating these complex injuries will assist in better understanding of fracture pattern and hence help in achieving a better functional outcome. Each fractured column needs to be independently addressed.

Keywords: Column concept; High energy; Luo’s classification; Tibial plateau fractures.

Fig. 1

Pre-operative CT scan of a patient showing a two column fracture with involvement of AL and posterior columns (both PL and PM fragments). Articular depression was also present. Standard anterolateral approach was used to fix the AL fragment, while posteromedial incision was used to fix PM and PL fragments. A cannulated screw was also used to support the elevated articular cartilage.

Fig. 2

Post-operative radiographs showing union. Excellent range of motion was achieved.

Fig. 3

Pre-operative CT scan of another case with a one column fracture (PM and PL fragments). PL column has a depressed articular fragment. This is an uncommon pattern of shearing posterior condylar fracture.

Fig. 4

Intra-operative photograph showing plating of both PL and PM fragments via the standard posteromedial incision. Cannulated screw was used to provide subchondral support to the elevated articular cartilage. Post-operative radiographs show union and good alignment. Excellent range of motion was achieved.