To assess the clinical effects of three-column reconstruction via the ranterolateral plus medial posterior approach in the treatment of three-column tibial plateau fractures.

The cases with tibial plateau fractures treated at our hospital from February 2013 to October 2016 were retrospectively reviewed. Thirty-two cases with closed three-column tibial plateau fractures who were treated by three-column fixation via the combined approach were included. These cases had complete clinical data, and there were 23 males and 9 females with an average age of 43.6 years. Tibial plateau-tibial shaft angle (TPA) and posterior angle (PA) were measured immediately after surgery and at the last follow-up for the affected limb. Stability of internal fixation was assessed. Hospital for special surgery knee score (HSS) was recorded at the last follow-up and functional recovery of the knee joint was assessed.

The 32 cases were followed for 6-33 months (average, 18.5 months). The time to bone fracture healing was 13-21 weeks with an average of 16 weeks, and the time to complete weight bearing was 18 weeks on average. There was no significant difference in TPA or PA immediately after surgery and at the last follow-up [(86.2^°±4.4^°) vs(84.5^°±4.4^°), t=1.58, P>0.05; (8.3^°±1.5^°) vs (9.2^°±1.6^°), t=-1.91, P>0.05]. The average knee joint range of motion was 2^°-121^° in the last follow-up, and HSS score was 87-96 (average, 93.5). One case had numbness in the posteroinferior part of the calf due to injury to the medial sural cutaneous nerve. This case recovered upon reexamination 6 months later. Incision healed well in all cases without injury to important vessels, loosening or fracture of internal fixation.

Three-column fixation via the anterolateral plus posteromedial approach for three-column tibial plateau fractures can achieve a good effect and stable fixation. The patients can start early functional training after surgery and the outcome is satisfactory.