Study of functional outcome in proximal tibia fracture fixation using three column concept
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262026Keywords:
Proximal tibia fracture, Three-column classification, Rasmussen score, Posterior column, Functional outcomeAbstract
Background: Proximal tibia fractures are complex intra-articular injuries often resulting from high-energy trauma. Traditional classification systems like Schatzker and AO/OTA rely on anteroposterior radiographs and may overlook posterior column injuries. The Three-column classification, introduced by Luo et al, utilizes computed tomography (CT) to address multiplanar fractures, particularly those involving the posterior column.
Methods: A prospective study was conducted on 80 patients with closed tibial plateau fractures at a tertiary care centre from January 2021 to January 2022. Fractures were classified using the Three-column concept. All patients underwent Open reduction and internal fixation (ORIF) using column-specific approaches. Functional outcomes were assessed after a minimum follow-up of 6 months using the modified Rasmussen clinical score.
Results: The mean age was 37.88±8.79 years, with a male preponderance (86.2%). Road traffic accidents were the most common mode of injury (88.7%). Two-column fractures were the most frequent (46.2%), followed by three-column fractures (32.5%). Functional outcomes were excellent in 17.5%, good in 68.7%, fair in 11.3%, and poor in 2.5% of cases. The mean Rasmussen score was significantly higher for one-column medial fractures (28±0) compared to two-column (24.05±1.54) and three-column fractures (24.80±1.35). Complications included superficial infection (11.3%), knee stiffness (8.7%) and screw pull-out (7.5%).
Conclusions: The Three-column concept provides a comprehensive understanding of fracture morphology, facilitating precise surgical planning for complex multiplanar injuries. Fixation based on this concept yields satisfactory functional outcomes, although multi-column injuries inherently carry a prognosis of lower functional scores compared to isolated column fractures.
References
Gahr P, Kopf S, Pauly S. Current concepts review: Management of proximal tibial fractures. Front Surg. 2023;10:1138274.
Munde R, Borkar S, Prabhu A, Madavi A, Doshi SS, Ravariya RV. A Prospective Study Comparing the Functional Outcomes of Complex Tibial Plateau Fractures Using Computed Tomography-based Three-column Theory Versus X-Ray-based Schatzker Classification. J Orthop Case Rep. 2025;15(12):315-20.
Liu M, Zhou Z, Wu C, Wu C, Fang R, Zhang C, et al. Breaking the treatment dilemma of Schatzker IV fractures: finite element analysis validates hybrid single-plate with tension screw fixation for synergistic optimization of stability and minimally invasive outcomes. Front Bioeng Biotechnol. 2025;13:1650132.
Bryson WN, Fischer EJ, Jennings JW, Hillen TJ, Friedman MV, Baker JC. Three-column classification system for tibial plateau fractures: What the orthopedic surgeon wants to know. Radiographics. 2021;41(1):144-55.
Selçuk E, Erem M, Çopuroğlu C, Özcan M, Çiftdemir M. Comparison of AO, Schatzker, and three-column classification systems in tibial plateau fractures: Impact on functional outcomes. Jt Dis Relat Surg. 2023;35(1):112-20.
Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010;24(11):683-92.
Kfuri M, Schatzker J. Revisiting the Schatzker classification of tibial plateau fractures. Injury. 2018;49(12):2252-63.
Tran HD, Nguyen QS, Le NTN. 3D printing and three column concepts in surgical treatment of tibial plateau fracture. Sci Rep. 2025.
Vosoughi F, Menbari OI, Rahimdoost N, Pesantez R. Decoding tibial plateau fracture classifications: a century of individualized insights in a systematic review. EFORT Open Rev. 2025;10(5):316-26.
Shen QJ, Zhang JL, Xing GS, Liu ZY, Li EQ, Zhao BC, et al. Surgical treatment of lateral tibial plateau fractures involving the posterolateral column. Orthop Surg. 2019;11(6):1029-38.
Jiang L, Zheng Q, Pan Z. Comparison of extended anterolateral approach in treatment of simple/complex tibial plateau fracture with posterolateral tibial plateau fracture. J Orthop Surg Res. 2018;13(1):1-8.
Wang Y, Luo C, Zhu Y, Zhai Q, Zhan Y, Qiu W, et al. Updated three-column concept in surgical treatment for tibial plateau fractures-a prospective cohort study of 287 patients. Injury. 2016;47(7):1488-96.
Krause M, Preiss A, Müller G, Frosch KH. Intra-articular tibial plateau fracture characteristics according to the “Ten segment classification”. Injury. 2016;47(11):2551-7.
Van DBJ, Reul M, Nunes CM, Starovoyt A, Geusens E, Nijs S, Hoekstra H. Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures. Int Orthop. 2017;41(9):1865-73.
Chen HW, Liu GD, Wu LJ. Clinical and radiological outcomes following arthroscopic-assisted management of tibial plateau fractures: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3464-72.
Zhu Y, Yang G, Luo CF, Zhang CQ, Hou ZY, Cui LL, et al. Computed tomography-based three-column classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility. J Trauma Acute Care Surg. 2012;73(3):731-7.
Brunner A, Horisberger M, Ulmar B, Hoffmann A, Babst R. Classification systems for tibial plateau fractures; does computed tomography scanning improve their reliability?. Injury. 2010;41(2):173-8.
Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am. 1973;55(7):1331-50.
Shah SV, Chacha S, Shah K, Kotak K, Shah A. Fracture evaluation of proximal tibia medial and posteromedial fracture pattern and its surgical-radiological outcome. Int J Med Pharm Res. 2025;6(6):1324-30.
Downloads
Published
How to Cite
Issue
Section
