Three-column Classification In The Fractures Of Tibial Following The Application And Research

Objective To contrast and analyse many Classifications of tibial plateau fractures and to evaluate the clinical value of them.Methods According to the Three Colunm Classification combined with Schatzker Classification, from January 2008 to May 2010,54 cases (56 side) of tibial plateau fractures in our hospital were treated. there were 2 pure compression fractures which were SchatzkerⅢ,15 posterior column fractures in which there were 3 SchatzkerⅠ,6 SchatzkerⅣ,6 SchatzkerⅤ; 18 lateral column in which there were 2 SchatzkerⅠ.,4 SchatzkerⅡ,12 SchatzkerⅤ; 7 medial column combined with posterior column fractures which were SchatzkerⅣ; 14 three-column fractures which were Schatzker VI. Anterior-lateral approach was used to treat pure compression fractures, reversed L-shaped or S-shaped approach was used to treat posterior column fractures, Anterior-lateral combined with reversed L-shaped or S-shaped approach was used to treat lateral column combined with posterior column fracture, modified midline combined with reversed L-shaped or S-shaped approach was used to treat medial column combined with posterior column fracture and anterior-lateral, medial combined with reversed L-shaped or S-shaped approach was used to treat three-column fracture.Results With a follow-up rate of 96.4%,54 sides were followed up 12 to 28 months (average 18.3).8 cases came up trauma arthritis.There was none case complicated with infection, delayed union, joint stark and all. The average radiographic bony union time was 12.6 weeks and the average full weight-bearing time was 14.9 weeks. At 1 month,6 months and 12 months postoperatively, the mean Hospital for Special Surgery (HSS) scores for all these patients were 65,90.2 and 92.5 respectively and the average ROM of the affected knee joints was 20°～90°,2°～116°and 1°～130°respectively; there were significant differences between the HSS scores and the average ROM of 1 month and them of 6 months or 12 months, there were no significant differences between the HSS scores and the average ROM of 6 months and them of 12 months.1 month post-operation 6 months post-operation and 12 months post-operation, the average angle of tibial plateau angle (TPA) was 88.3°+3.2°,89.2°±4.8°and 89.6°±5.3°, the average angle of posterior slope angle (PA) was 8.3°±3.2°,8.7°±3.4°and 9.0°±3.5°, respectively. There were no sign-ificant differences in both tibial plateau angle (TPA) and posterior slope angle (PA) on the radiographies amoung 1 months post-operation,6 months post-operation and 12 months post-operation.Conclusion Three-Column Classification offsets the shortage of Schatzker Classification in instructing in the classification and the treatment of posterior column tibial plateau fractures, Schatzker Classification offsets the shortage of Three-Column Classification in not describing the pure compression fractures. The two classification combined is more theory and reliable.