Age-Related Variances in Patients with Tibial Plateau Fractures

Abstract

Tibial plateau fractures account for approximately 8% of fractures in the elderly population. Treatment strategies in the elderly are similar to those for younger patients; however, practitioners must account for the elevated comorbidity burden in this population. To date, few studies have analyzed age-based outcomes in patients with tibial plateau fractures. Therefore, the purpose of this study was to determine age-related variances in demographics, fracture characteristics, mechanism of injury, and complications. A 10-year retrospective review was conducted to identify patients who received treatment for a tibial plateau fracture. There were 351 patients (360 tibial plateau fractures) who were identified and subsequently stratified according to their age at the time of injury. Patients were classified as elderly if they were 65 years of age or older at the time of injury; all other patients were included in the control cohort. These two cohorts were analyzed using bivariate analysis to isolate for age-related variations with respect to risk factors, mechanism of injury, and complications. There were 351 patients (360 tibial plateau fractures) with a median follow-up of 1.84 ± 2.44 years who met inclusion criteria. There were a greater proportion of women in the elderly cohort as compared with the younger cohort (60.0 vs. 43.4%, p = 0.06). Elderly patients were significantly more likely to present with diabetes (33.3 vs. 16.1%, p = 0.01) or osteoporosis (14.3 vs. 1.6%, p = 0.001). Younger patients were significantly more likely to require further surgery to address ligament (12.6 vs. 0%, p = 0.008), meniscus (20.9 vs. 7.1%, p = 0.036), or cartilage pathology (13.6 vs. 0%, p = 0.005). There was no difference in the arthroplasty conversion rate (4.8% elderly vs. 7.9% control, p = 0.755). While elderly patients presented with a greater comorbidity burden, they had equivalent or better short-term outcomes when compared with their younger peers when treated with open reduction and internal fixation (ORIF). Despite the recent interest in primary total knee arthroplasty for elderly patients with tibial plateau fractures, the results of this study suggest that elderly patients may respond well when treated with ORIF following a tibial plateau fracture.

Tibial plateau fractures in Belgium: epidemiology, financial burden and costs curbing strategies

“…Lastly, frail elderly patients often have a significant number of comorbidities combined with reduced mobility, which results in a more wait and see attitude. However, as age is not an independent risk facture and elderly patients are not prone to infection [6,10,11]. As the used database is an insurance and cost oriented database, composed and controlled by the government it unfortunately does not allow us to diversify into supplementary data that is of interest to the trauma surgeon (e.g.…”

“…Morbidity increases with the age; malalignment, fracture related infection, non-union, and other postoperative complications, have far-reaching consequences, not only functionally but also financially [4,5]. At long term, post-traumatic osteoarthritis occurs in 25% to 45%, with a 10-year likelihood of 3%-7% for total knee arthroplasty (TKA) and increase of total healthcare costs, subsequently [6]. We recently demonstrated that the rate of surgery for clavicular fractures in Belgium has almost doubled in 10 years, while the indication for this is still under debate [2].…”

Primary total knee replacement for tibial plateau fractures in older patients: a systematic review of 197 patients

“…However, to acceptably reduce the joint surface, achieve knee stability and restore the mechanical axis can be challenging due to possible complexity of the fracture or inferior bone quality. ORIF has shown good results in some studies, with low rates (0-9.5%) of complications in older patients [8,9,13,16,17,19]. However, some problems seem to be associated specifically with tibial plateau fractures treated using ORIF.…”

“…Some studies have found a high risk of complications, such as infections, loss of reduction, malalignment, delayed union or nonunion, and risk for the development of post-traumatic osteoarthritis (OA) [6,[9][10][11][12][13][14][15]. However, many other studies have reported ORIF to have good outcomes in older people [8,[16][17][18][19][20].…”

Radiological Outcome Measures Indicate Advantages of Precontoured Locking Compression Plates in Elderly Patients With Split-Depression Fractures to the Lateral Tibial Plateau (AO41B3)

“…Fractures to the tibial plateau account for approximately 1–2% of all fractures in the general population but for up to 8% of all fractures in the elderly. 1 , 2 While younger patients predominately suffer traffic accidents, high impact sport injuries, or falls from greater height, elderly patients often mainly suffer simple falls or low velocity traumata resulting in a tibial plateau fracture. The loss of bone mass and the deterioration of the bone microarchitecture with age contribute to this change of causal injury mechanism.…”