Limited value of the column concept in the operative management of posterior column tibial plateau fractures
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ORIGINAL ARTICLE
Limited value of the column concept in the operative management of posterior column tibial plateau fractures Juriaan van den Berg1 · Stefaan Nijs1,2 · Harm Hoekstra1,2 Received: 24 August 2018 / Accepted: 18 January 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Introduction The three-column concept has been proposed as tool in surgical decision-making for treating tibial plateau fractures. Recent studies have underscored the negative effect of posterior column tibial plateau fractures on clinical outcome. The purpose of this study was to assess the value of the three-column concept and posterior plating in posterior column fractures. We hypothesized that treating patients according to the three-column concept improves functional outcome. Methods 111 consecutive tibial plateau fractures, treated between January 2009 and December 2016, with at least a posterior column fracture were included. Relevant demographic and treatment variables were studied. Applied treatment was retrospectively evaluated according to the three-column concept. Patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Results Median follow-up was 43.1 months (IQR 29.0–63.3) with a response rate of 80.2%. Outcome scores were markedly lower compared to the general population. 22.5% patients were treated according to the three-column concept and 27% was treated with posterior plating. Predominantly combined fractures of posterior and lateral columns were treated without fixation of the posterior column. Neither treatment according to the three-column concept and/or with posterior plating was found to significantly influence outcome. Conclusions The outcome of posterior column fractures was equal, regardless of whether these fractures were treated or not. This indicates that the three-column concept seems insufficient and gives rise to further debate on surgical strategies of posterior column fractures. The implementation of trauma mechanism-based fracture morphology in the three-column concept might be important to consummate the three-column concept as guiding tool. Level of evidence 3. Keywords Three-column concept · Tibial plateau fractures · Posterior column · Functional outcome Abbreviations PCF Posterior column fracture TCC Three-column concept ORIF Open reduction and internal fixation KOOS Knee injury and osteoarthritis outcome score
* Harm Hoekstra [email protected] 1
Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
Department of Development and Regeneration, KU Leuven-University of Leuven, 3000 Leuven, Belgium
2
Introduction The reported incidence of posterior involvement in proximal tibial plateau fractures ranges from 28.8 to 70.7% [1–3]. Outcome of these posterior column fractures (PCF) is not widely described in the literature, but the recent studies suggest that involvement of the posterior surface of the tibial plateau has more impact on outcome than previously apprec
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