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.
Keywords
Tibial Plateau Fracture - posttraumatic osteoarthritis - knee replacement - elderly
