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Three-Column Classification for tibial plateau fractures
5
Zitationen
3
Autoren
2009
Jahr
Abstract
Objective To evaluate the clinical value of a CT-based three dimensional classification system, in treatment of tibial plateau fractures. Methods From De-cember 2004 to march 2007, a new classification system, Three-Column Classification, was used for deter-minining fixation method and surgery approach in 323 cases of tibial plateau fractures prospectively. All the patients were treated with open reduction and internal fixation. According to the Three-Column Classification, there were 4 pure compression fractures, 181 one-column fractures, 108 two-column fractures and 30 three-column fractures. Anterior-lateral, modified midline and reversed L-shaped approaches were used to treat lateral column, medial column and posterior column fractures respectively. Combined approaches were applied for double-column and three-column fractures. Results The mean operative time for one-column, two-column and three-column fractures were 72.3, 87.5, and 97.2 minutes, respectively. With a follow-up rate of 87.8%, 267 cases were followed up for an average of 20.3 (12 to 35) months. The average radio-graphic bony union time was 14. 6 weeks and the average full weight-bearing time was 15.9 weeks. The mean Short Form 36 (SF-36) and Hospital for Special Surgery (HSS) scores for all these patients at 12 months postoperatively were 90.7 and 87.8, respectively. The average ROM of the affected knee joints was 2°to 123°. There were no significant differences in both tibial plateau angle (TPA) and posterior slope angle (PA) on the radiographies between immediate post-operation and 12 months post-operation. Delayed union occurred in 5 eases, and screw loosening in 2 postoperatively. There were 6 cases of superficial infection and 5 ones of partial incision necrosis which were healed with wound management. One deep infection diminished after de-bridement and implant removal. Numbness in the posterior-inferior part of the calf was recorded in 3 cases. Conclusion CT-based Three-Column Classification is more reliable and instructive in the treatment of complex tibia] plateau fractures, especially when the fracture involves the posterior column. Key words: Tibial fracture; Fracture fixation, internal; Classification; Three-column
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