Does 4 column classification of upper tibia fracture gives you better idea of fixation and impact on clinical outcome-analysis of 50 cases?

Abstract

The management of proximal tibia fracture has underdone significant changes in the recent years, while the main goals remain same i.e. to achieve a smooth articular surface, mechanical axis and joint stability. Recent advances in computed tomography and MRI based imaging have led to better understanding and classification of fracture and therefore better planning for treatment.This is a prospective analysis of the proximal tibia fracture managed as per 4 column 10 segment concept in view of functional outcomes. Radiological and functional outcomes using knee society score of the proximal tibia fractures operated and classified as per computed tomography based 4 column 10 segment concept were studied at 6 weeks, 3 months, 6 months and 9 months from year 2019 to 2022.Mean age of population sustaining proximal tibia fracture among males was 43.90 years and females was 48.71y with 86% predilection for male and 14% for female. Involvement of right tibia was 50 % in comparison to left tibia which was 46%, while 4% patients had involvement of both limbs. Distribution of proximal tibia fracture ; zero column -7.69%, one column- 55.77%, two column-21.15%, three column-15.38% average knee society score for proximal tibia fracture at the end of 9 months (knee score, function score) 87.65;79.54.Single incident of superficial infection was encountered managed with debridement and parenteral antibiotics. Single incident of surgical site infection managed with implant removal, debridement and parenteral antibiotics as per culture sensitivity. Single incident of common peroneal nerve palsy was encountered repaired with extended Lobenhoffer approach.Recent computed tomography based classification are very useful for fixation and deciding most suited surgical approach for proximal tibia fractures to achieve a smooth articular surface, mechanical axis and joint stability. Still, a long-term study with large study group is needed to confirm the usefulness of the same.