Epidemiology and outcomes of tibial plateau fractures in adults aged 60 and over treated in the United Kingdom

Donovan, Richard L; Smith, James; Yeomans, Daniel; Bennett, Fenella; Smallbones, Matthew; White, Paul; Chesser, Tim

doi:10.1016/j.injury.2022.03.048

Cited by 11 publications

(16 citation statements)

References 13 publications

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“…Consistent with previous studies, Schatzker II fractures predominated in patients aged ≥ 60 years with TPFs 2,23 and in those who go on to require late TKA 24 as opposed to more complex bicondylar patterns. The current study demonstrated that joint depression rather than bicondylar involvement was associated with TKA requirement.…”

Section: Discussionsupporting

confidence: 90%

“…8-10 A recent paper on the TPF epidemiology in patients aged > 60 years, which included both operatively (40%) and nonoperatively managed (60%) cases, reported a rate of late TKA of 8%. 2 Though this is at the upper end of previous studies, it is not as high as the current study. Nonoperative management in this older age group may have been dictated by frailty or comorbidity rather than by fracture characteristics.…”

Section: Discussioncontrasting

confidence: 67%

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Pre-existing knee osteoarthritis and severe joint depression are associated with the need for total knee arthroplasty after tibial plateau fracture in patients aged over 60 years

Gupta,

Sadczuk,

Riddoch

et al. 2024

Bone Joint J

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AimsThis study aims to determine the rate of and risk factors for total knee arthroplasty (TKA) after operative management of tibial plateau fractures (TPFs) in older adults.MethodsThis is a retrospective cohort study of 182 displaced TPFs in 180 patients aged ≥ 60 years, over a 12-year period with a minimum follow-up of one year. The mean age was 70.7 years (SD 7.7; 60 to 89), and 139/180 patients (77.2%) were female. Radiological assessment consisted of fracture classification; pre-existing knee osteoarthritis (OA); reduction quality; loss of reduction; and post-traumatic OA. Fracture depression was measured on CT, and the volume of defect estimated as half an oblate spheroid. Operative management, complications, reoperations, and mortality were recorded.ResultsNearly half of the fractures were Schatzker II AO B3.1 fractures (n = 85; 47%). Radiological knee OA was present at fracture in 59/182 TPFs (32.6%). Primary management was fixation in 174 (95.6%) and acute TKA in eight (4.4%). A total of 13 patients underwent late TKA (7.5%), most often within two years. By five years, 21/182 12% (95% confidence interval (CI) 6.0 to 16.7) had required TKA. Larger volume defects of greater depth on CT (median 15.9 mm vs 9.4 mm; p < 0.001) were significantly associated with TKA requirement. CT-measured joint depression of > 12.8 mm was associated with TKA requirement (area under the curve (AUC) 0.766; p = 0.001). Severe joint depression of > 15.5 mm (hazard ratio (HR) 6.15 (95% CI 2.60 to 14.55); p < 0.001) and pre-existing knee OA (HR 2.70 (95% CI 1.14 to 6.37); p = 0.024) were independently associated with TKA requirement. Where patients with severe joint depression of > 15.5 mm were managed with fixation, 11/25 ultimately required TKA.ConclusionOverall, 12% of patients aged ≥ 60 years underwent TKA within five years of TPF. Severe joint depression and pre-existing knee arthritis were independent risk factors for both post-traumatic OA and TKA. These features should be investigated as potential indications for acute TKA in older adults with TPFs.Cite this article: Bone Joint J 2024;106-B(1):28–37.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 67%

Pre-existing knee osteoarthritis and severe joint depression are associated with the need for total knee arthroplasty after tibial plateau fracture in patients aged over 60 years

Gupta,

Sadczuk,

Riddoch

et al. 2024

Bone Joint J

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“…Ostesoporotic tibial plateau fracture is not common in elderly. Schatzker types I, II, and III fractures are main fracture type because of low-energy trauma ( 66 ). Conservative treatment through cast or orthosis is indicated for patients with small or non-displacement.…”

Section: Bone Augmentation Strategies For Common Osteoporotic Fracturesmentioning

confidence: 99%

Expert consensus on the bone repair strategy for osteoporotic fractures in China

Zhang

Yan²,

Chen³

et al. 2022

Front. Endocrinol.

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Osteoporotic fractures, also known as fragility fractures, are prevalent in the elderly and bring tremendous social burdens. Poor bone quality, weak repair capacity, instability, and high failure rate of internal fixation are main characteristics of osteoporotic fractures. Osteoporotic bone defects are common and need to be repaired by appropriate materials. Proximal humerus, distal radius, tibia plateau, calcaneus, and spine are common osteoporotic fractures with bone defect. Here, the consensus from the Osteoporosis Group of Chinese Orthopaedic Association concentrates on the epidemiology, characters, and management strategies of common osteoporotic fractures with bone defect to standardize clinical practice in bone repair of osteoporotic fractures.

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“…Secondary outcomes included assessing change following TPF in HRQoL using the EQ-5D and EQ-VAS, 1 , 2 and joint/limb specific functional outcomes measured using the OKS and LEFS, 3 and what aspects of TPF treatment were most important to patients using the 12 patient questionnaire.…”

Section: Methodsmentioning

confidence: 99%

“…Tibial plateau fractures (TPFs) account for 8% of all fractures in older adults 1 . Lower limb trauma in older adults is often complicated by poor bone stock, tissue fragility, pre-existing osteoarthritis (OA), patient comorbidities, frailty, and low pre-fracture mobility and functionality.…”

Section: Introductionmentioning

confidence: 99%

Tibial plateau fractures in older adults are associated with a clinically significant deterioration in health-related quality of life

et al. 2023

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AimsTo investigate health-related quality of life (HRQoL) of older adults (aged ≥ 60 years) after tibial plateau fracture (TPF) compared to preinjury and population matched values, and what aspects of treatment were most important to patients.MethodsWe undertook a retrospective, case-control study of 67 patients at mean 3.5 years (SD 1.3; 1.3 to 6.1) after TPF (47 patients underwent fixation, and 20 nonoperative management). Patients completed EuroQol five-dimension three-level (EQ-5D-3L) questionnaire, Lower Limb Function Scale (LEFS), and Oxford Knee Scores (OKS) for current and recalled prefracture status. Propensity score matching for age, sex, and deprivation in a 1:5 ratio was performed using patient level data from the Health Survey for England to obtain a control group for HRQoL comparison. The primary outcome was the difference in actual (TPF cohort) and expected (matched control) EQ-5D-3L score after TPF.ResultsTPF patients had a significantly worse EQ-5D-3L utility (mean difference (MD) 0.09, 95% confidence interval (CI) 0.00 to 0.16; p < 0.001) following their injury compared to matched controls, and had a significant deterioration (MD 0.140, 95% CI 0 to 0.309; p < 0.001) relative to their preoperative status. TPF patients had significantly greater pre-fracture EQ-5D-3L scores compared to controls (p = 0.003), specifically in mobility and pain/discomfort domains. A decline in EQ-5D-3L greater than the minimal important change of 0.105 was present in 36/67 TPF patients (53.7%). Following TPF, OKS (MD -7; interquartile range (IQR) -1 to -15) and LEFS (MD -10; IQR -2 to -26) declined significantly (p < 0.001) from pre-fracture levels. Of the 12 elements of fracture care assessed, the most important to patients were getting back to their own home, having a stable knee, and returning to normal function.ConclusionTPFs in older adults were associated with a clinically significant deterioration in HRQoL compared to preinjury level and age, sex, and deprivation matched controls for both undisplaced fractures managed nonoperatively and displaced or unstable fractures managed with internal fixation.Cite this article: Bone Jt Open 2023;4(4):273–282.

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Epidemiology and outcomes of tibial plateau fractures in adults aged 60 and over treated in the United Kingdom

Cited by 11 publications

References 13 publications

Pre-existing knee osteoarthritis and severe joint depression are associated with the need for total knee arthroplasty after tibial plateau fracture in patients aged over 60 years

Pre-existing knee osteoarthritis and severe joint depression are associated with the need for total knee arthroplasty after tibial plateau fracture in patients aged over 60 years

Expert consensus on the bone repair strategy for osteoporotic fractures in China

Tibial plateau fractures in older adults are associated with a clinically significant deterioration in health-related quality of life

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