Clinical efficacy observation of the four pillar concept in the treatment of Schatzker type I-IV tibial plateau fractures

Corresponding author: wuyunfei, 849893410@qq.com

DOI: 10.12201/bmr.202411.00018

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  Abstract: Objective: To explore the four pillar concept in the treatment of tibial plateau fractures, compare the imaging examination results and clinical efficacy of the four pillar concept and Schatzker classification concept in the treatment of type I-IV tibial plateau fractures, and evaluate the effectiveness and practicality of this concept. Method: A prospective cohort study was conducted to analyze 70 patients with tibial plateau fractures treated in our hospital from September 1, 2022 to April 30, 2023. They were divided into a treatment group (four column concept group) and a control group (Schatzker classification concept group) according to different surgical methods, with 35 patients in each group. All patients undergo complete X-ray and CT three-dimensional reconstruction examinations, and undergo regular knee joint X-ray anteroposterior and lateral radiograph follow-up after surgery. We collected data at 1 month and 1 year after surgery, including measurements of Posterior Tibial Slope (PTS), Tibial Plateau Inverted Angle (mTPA), secondary displacement of the articular surface, as well as Visual Analog Scale (VAS), Knee Flexion ROM (°), Lysholm Score, and Knee Joint Function Score (HSS). The results showed a significant difference in surgical time and bleeding volume between the two groups (p<0.001), indicating that the treatment group was superior to the control group in terms of surgical time and bleeding volume. There was no statistically significant difference in incision length, suture removal time, and hospitalization time (p>0.05). The interaction effect between the PTSA group, measurement frequency, and group was significant (p<0.001), indicating that there were statistically significant changes in PTSA at different times and in different groups after surgery. The main effect, measurement frequency, and interaction effect between measurement frequency and group were significant (p<0.001) in the group with secondary articular surface collapse, indicating that there were statistically significant measurements at different times in different groups after surgery for secondary articular surface collapse. The main effect, measurement frequency, and interaction effect between the mPTA group and the group were not significant (p>0.05), indicating that there was no statistical significance in the measurement of mPTA at different times in different groups after surgery. The VAS scores of both groups of patients showed significant improvement at 1 year after surgery compared to 1 month after surgery (p<0.001). The main effect, measurement frequency, and interaction effect between ROM (°) and Lysholm score and group were significant (p<0.001), indicating that ROM (°) and Lysholm score were statistically significant at different time points in different groups after surgery. The main effect of HSS score was significant (p<0.001), indicating that HSS score was statistically significant at different time points in different groups after surgery, but there was no interactive significance. Conclusion: The four pillar concept is based on the consideration of four injury mechanisms, four pillar classification, and four surgical approaches of the tibial plateau. At the same time, it introduces the main problem bone pillar and soft tissue diagonal principle to guide the surgical sequence and internal fixation principles. It can effectively restore the alignment and fixation strength of the fracture end, and improve the range of motion of the knee joint. Therefore, the surgical treatment of Schatzker type I-IV tibial plateau fractures guided by the four pillar concept has good clinical efficacy and is worthy of promotion and application in clinical practice.

  Key words: four-column classification system; Schatzker typing; tibial plateau fracture

  Submit time: 9 November 2024

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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