Updated Three-Column Concept in surgical treatment for tibial plateau fractures – A prospective cohort study of 287 patients

Wang, Yukai; Zhu, Yun; Zhai, Qilin; Zhan, Yu; Qiu, Weijian; Xu, Yishen

doi:10.1016/j.injury.2016.04.026

Cited by 126 publications

(118 citation statements)

References 28 publications

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“…Epidemiological and morphological studies of TPFs have been reported to improve the concept and surgical techniques of the treatment [2, 3, 14, 15]. Previously, almost all TPFs-centred studies have analyzed the patients of different age groups as a whole, which possibly confounded the distinctions among age groups [16, 17].…”

Section: Discussionmentioning

confidence: 99%

“…The results of this study found a clear indication that the posterior column fracture was also associated with high morbidity in elderly patients (67.58%), and the PL sub-column (62.69%) was more often involved than the PM sub-column (37.92%). According to the updated TCC protocol, a ruptured posterolateral wall often needs to be exposed and buttressed [14]. However, because the access to the PL fracture is hindered by the fibula and peroneal nerve to the anterior and by the popliteal neurovascular structures to the posterior, the risk of iatrogenic damage to these adjacent structures during exposure and fixation is high [35–37].…”

Section: Discussionmentioning

confidence: 99%

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Tibial plateau fractures in elderly people: an institutional retrospective study

Sun

Shu

et al. 2018

J Orthop Surg Res

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BackgroundTibial plateau fractures are the most common intra-articular fractures, which require careful evaluation and preoperative planning. The treatment of tibial plateau fractures in elderly patients is challenging, and the comprehension of epidemiology and morphology can be helpful. This study described the characteristics of geriatric tibial plateau fractures.MethodsA total of 327 (23.24%) patients aged ≥60 years were reviewed in our level one trauma center over a 4-year period (from January 2013 to November 2016). The following parameters were collected and evaluated: (1) demographic data, (2) injury mechanisms and (3) fracture classifications.ResultsFemales accounted for 60.86% in all included elderly patients. Electric-bike accidents were the cause of 32.42% of all these injuries, and 39.62% of these led to high-energy injuries. The most common type of fracture was Schatzker II (54.74%). According to the three-column classification, single lateral column fracture (28.75%) and four-quadrant fracture (involving lateral, medial, posterolateral and posteromedial fractures) (23.24%) were the two most frequent patterns. In all cases, 67.58% involved the posterior column, and the prevalence of posterolateral and posteromedial fractures were 62.69% and 37.92% respectively. Isolated posterior column fractures accounted for 12.54% of patients in total, which mostly consisted of posterolateral fracture in older females (85.37%).ConclusionsThe majority of elderly patients with tibial plateau fractures are females, and Electric-bike accidents are an important cause of injury. Geriatric tibial plateau fractures have unique distribution in classification.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tibial plateau fractures in elderly people: an institutional retrospective study

Sun

Shu

et al. 2018

J Orthop Surg Res

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“…For BTPFs with an extension injury mechanism, a semi-flexed position (20-40° flexion) and valgus or varus traction during the reduction procedure are recommended to counter the initial injury mechanism. The posterolateral fragment can be fixed to the anterolateral fragment through an extended anterolateral incision via a single 3.5 mm lateral rafting locking plate [29,30]; a displaced posteromedial fragment always needs a posteromedial approach [3] with a buttress plate to achieve reduction [4,31]. Traction in an extended position with external or internal rotation of the tibia is useful for reducing the flexioninternal rotation and flexion-external rotation types of BTPFs, respectively.…”

Section: Flexion-external Rotation Injury Mechanismmentioning

confidence: 99%

Bicondylar Tibial Plateau Fractures Involving the Posterior Fragment: Injury Mechanism and Fracture Characteristics

Pan

Peng

et al. 2020

Preprint

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Background: Bicondylar tibial plateau fracture (BTPF) involving the posterior fragment is the most complex intra-articular fracture to treat. Although the fracture characteristics of BTPFs have been reported by many researchers, due to the sophisticated kinematics of the knee, reports focused on the injury mechanism are still scarce. The current injury mechanism is insufficient to explain the various fracture characteristics and to guide surgery. This study used a three-dimensional (3D) simulation method to investigate the injury mechanism and fracture characteristics of BTPFs involving the posterior fragment. Methods: Ninety-six BTPFs involving the posterior fragment were included. A computer-assisted 3D technique, which enabled us to move the femoral condyles to match the displaced fracture fragments of the tibial plateau, was applied to analysis the injury mechanism for all cases. The 3D and two-dimensional (2D) morphology of each fracture were reviewed thoroughly, and the main fracture lines were mapped and superimposed on a template. Results: After simulation and quantitatively analysis, three main types (extension, flexion-internal rotation, flexion-external rotation) and six sub-types (valgus and varus in each main type) of injury mechanism had been classified according to the degree of knee motion in three planes. In the extension type, femoral condyles compress the anterolateral tibial plateau and central medial plateau, resulting in an anterior-to-posterior fracture line. In the flexion-internal rotation type, the compressed areas are located on the posterolateral and anteromedial plateau, forming an oblique anteromedial-to-posterolateral fracture line. In the flexion-external rotation type, the compressed areas are located on the anterolateral and posteromedial plateau, exhibiting an anterolateral-to-posteromedial fracture line. Conclusions: Different injury mechanisms result in different fracture characteristics. A thorough understanding of the injury mechanisms underlying complex BTPFs involving the posterior fragment is meaningful not only for fracture characteristics reorganization but also for surgical decision making. The 3D simulation method employed in this study may be a useful supplemental method for investigating the mechanisms underlying fracture injuries.

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“…9 This has subsequently been updated and termed the 'updated threecolumn concept'. 10 This classification system divides the tibial plateau into lateral, medial and posterior columns in order to improve surgical decision-making. The identification of posterolateral and posteromedial coronal shear fractures has been documented.…”

Section: Chertsey Classificationmentioning

confidence: 99%

Tibial plateau fractures – review of current concepts in management

Jeelani

Arastu

2017

Orthopaedics and Trauma

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Updated Three-Column Concept in surgical treatment for tibial plateau fractures – A prospective cohort study of 287 patients

Cited by 126 publications

References 28 publications

Tibial plateau fractures in elderly people: an institutional retrospective study

Tibial plateau fractures in elderly people: an institutional retrospective study

Bicondylar Tibial Plateau Fractures Involving the Posterior Fragment: Injury Mechanism and Fracture Characteristics

Tibial plateau fractures – review of current concepts in management

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