Session III Tibia

Friday, September 27, 1996 Session III, 4:24 p.m.

Tibial Plateau Fractures in the Older Patient

J.F. Keating, MD, A. Levy

Edinburgh Royal Infirmary, Scotland, UK

Purpose: The purpose of this study was to study the epidemiology and clinical features of tibial plateau fractures in patients over the age of 60 years.

Methods: In the time interval between 1988 and 1994, 157 consecutive tibial plateau fractures in patients over 60 years were treated. Radiographs were analyzed and classified using the system described by Schatzker. Patients were asked to return for radiographic follow-up and arthritic changes were graded using the system of Almekinders and Logan. Complications of treatment were recorded, and the need for total knee arthroplasty.

Results: There were 34 males and 123 females with a mean age of 74 years (range 60 years to 96 years). Split fractures comprised 15% of the total, central depression 20%, split depression 34%, medial plateau fractures 13%, bicondylar 12% and combined plateau metaphyseal injuries 6%. The majority of these fractures (103) were managed in simple splints. Forty cases (25%) were treated by open reduction and internal fixation and 8 cases (5%) were treated by external fixation. The remainder were minor fractures treated by rest and analgesics. Of those treated operatively, the majority had internal fixation with buttress plating. The complication rates were low - there were 2 deep infections, and one skin flap necrosis. At the time of presentation, 80% of patients were independently mobile but at follow-up this percentage had declined to 52%. The remaining patients required some form of assistance, most commonly a stick (24%). Radiographs on fifty-nine patients who returned for review demonstrated significant osteoarthritic changes in 34 cases (57%). A further two patients had required a total knee arthroplasty due to post-traumatic arthritis. At the time of follow-up 27% of the patients were deceased.

Discussion: In contrast to younger patients tibial plateau in older patients usually affect women and central depression and split depression are the most common forms. The majority can be treated non-operatively in the expectation of a good result.

Conclusion: Tibial plateau fractures in patients over the age of 60 years are largely confined to the female population. They result in a high incidence of radiographic arthritis but the ultimate requirement for total knee arthroplasty is low.