A Prospective Study Comparing the Functional Outcomes of Complex Tibial Plateau Fractures Using Computed Tomography-based Three-column Theory Versus X-Ray-based Schatzker Classification Treated with Open Reduction with Locking Compression Plates.

Introduction: Tibial plateau fractures are complex intra-articular injuries that require precise classification for optimal management. The widely used Schatzker classification, based on X-rays, provides a two-dimensional assessment, while the computed tomography (CT)-based three-column theory offers a more detailed three-dimensional analysis. This study aimed to compare the functional outcomes of complex tibial plateau fractures classified using these two systems and treated with locking compression plates (LCP). Materials and Methods: A prospective, observational study was conducted involving 44 patients with closed Schatzker type V and VI tibial plateau fractures. Patients were allocated into two groups: Group A (n = 22) based on CT-based three-column classification and Group B (n = 22) based on X-ray-based Schatzker classification. All patients underwent open reduction and internal fixation using anatomical LCPs. Functional outcomes were assessed using the Rasmussen clinical score at regular follow-ups. Intraoperative variables and post-operative complications were also analyzed. Results: Group A showed significantly better Rasmussen scores at 6, 12, 24, and 36 weeks (P < 0.05), along with shorter operative time, reduced blood loss, lower radiation exposure, and fewer complications compared to Group B. Joint stiffness and post-traumatic arthritis were notably higher in the Schatzker group. Conclusion: CT-based three-column classification enables more accurate surgical planning and leads to superior functional and perioperative outcomes in complex tibial plateau fractures compared to the Schatzker classification.