Study of functional outcome in proximal tibia fracture fixation using three column concept

Deepak D. Chitragar; S. Kavin; V. Atchutha Ramaiah

doi:10.18203/issn.2455-4510.IntJResOrthop20262026

Authors

Deepak D. Chitragar Department of Orthopaedics, Kauvery Hospital, Tiruchirapalli, Tamil Nadu, India
S. Kavin Department of Orthopaedics, Kauvery Hospital, Tiruchirapalli, Tamil Nadu, India
V. Atchutha Ramaiah Department of Orthopaedics, Tirumala Hospital, Vizianagaram, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262026

Keywords:

Proximal tibia fracture, Three-column classification, Rasmussen score, Posterior column, Functional outcome

Abstract

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.

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