Outcomes of Tibial Plateau Fracture Surgical Fixation: a Comparative Study Between Younger and Older Age Groups

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, AJA University of Medical Sciences, Tehran, Iran

2 Department of Orthopedic, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Tibial plateau fractures account for approximately 8% of the fractures of the elderly. Low bone quality that is more common in the elderly is one of the major challenges in fixing fractures and may be a barrier to achieving satisfactory outcomes after a surgical fracture treatment. Accordingly, surgical fixation of tibial plateau fractures was controversial in the elderly. This study aimed to investigate and compare the clinical outcomes of surgical fixation in patients over and under 60 years of age. Methods: This study was conducted as a retrospective cohort study of data that were prospectively collected. In total, 48 patients who underwent surgery with open reduction and internal fixation before August 2019 were recruited and followed up at least one year after surgery. Demographic characteristics, the range of motion of the knees, visual analog scale (VAS) score of pain intensity, and the Oxford Knee Score (OKS) were obtained in this study. Furthermore, Short Form-36 (SF-36) questionnaire was used to evaluate patient satisfaction. Results: In total, 19 and 29 patients were over and under 60 years of age, respectively. According to Schatzker’s classification, the most common type of fracture was type VI. The range of motion in the knees did not differ significantly between the two groups (P>0.05). Moreover, OKS and the VAS of pain intensity were not significantly different in both groups (P>0.05). In addition, SF-36 scores were not significantly different between elderly patients and the age-matched general population. However, younger patients had lower scores in the physical function and vitality scales of SF-36, compared to the age-matched general population. Conclusion: Based on the results of the present study, it can be stated that increasing age did not affect the surgical outcomes of patients with tibial plateau fractures. Level of evidence: III

Keywords


1. Egol KA, Koval KJ, Zuckerman JD. Handbook of fractures: Lippincott Williams & Wilkins; 2010.
2. Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN. Complications after tibia plateau fracture surgery. Injury. 2006;37(6):475-84.
3. Young MJ, Barrack R. Complications of internal fixation of tibial plateau fractures. Orthopaedic review. 1994;23(2):149-54.
4. Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results. Clinical orthopaedics and related research. 1993(292):87-100.
5. Lansinger O, Bergman B, Körner L, Andersson G. Tibial condylar fractures. A twenty-year follow-up. The Journal of bone and joint surgery American volume. 1986;68(1):13-9.
6. Schatzker J, Mcbroom R, Bruce D. The tibial plateau fracture: the Toronto experience 1968–1975. Clinical Orthopaedics and Related Research®. 1979(138):94-104.
7. Ali AM, El-Shafie M, Willett KM. Failure of fixation of tibial plateau fractures. J Orthop Trauma. 2002;16(5):323-9.
8. Stevens DG, Beharry R, McKee MD, Waddell JP, Schemitsch EH. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma. 2001;15(5):312-20.
9. Biyani A, Reddy NS, Chaudhury J, Simison AJ, Klenerman L. The results of surgical management of displaced tibial plateau fractures in the elderly. Injury. 1995;26(5):291-7.
10. Elsoe R, Johansen MB, Larsen P. Tibial plateau fractures are associated with a long-lasting increased risk of total knee arthroplasty a matched cohort study of 7,950 tibial plateau fractures. Osteoarthritis and Cartilage. 2019;27(5):805-9.
11. Oladeji LO, Dreger TK, Pratte EL, Baumann CA, Stannard JP, Volgas DA, et al. Total knee arthroplasty versus osteochondral allograft: prevalence and risk factors following tibial plateau fractures. The journal of knee surgery. 2019;32(04):380-6.
12. Pinter Z, Jha AJ, McGee A, Paul K, Lee S, Dombrowsky A, et al. Outcomes of knee replacement in patients with posttraumatic arthritis due to previous tibial plateau fracture. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. 2020;30(2):323-8.
13. Roerdink WH, Oskam J, Vierhout PA. Arthroscopically assisted osteosynthesis of tibial plateau fractures in patients older than 55 years. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2001;17(8):826-31.
14. Su EP, Westrich GH, Rana AJ, Kapoor K, Helfet DL. Operative treatment of tibial plateau fractures in patients older than 55 years. Clinical Orthopaedics and Related Research®. 2004;421:240-8.
15. Timmers TK, van der Ven DJ, de Vries LS, van Olden GD. Functional outcome after tibial plateau fracture osteosynthesis: a mean follow-up of 6 years. The Knee. 2014;21(6):1210-5.
16. Stevenson I, McMillan TE, Baliga S, Schemitsch EH. Primary and Secondary Total Knee Arthroplasty for Tibial Plateau Fractures. The Journal of the American Academy of Orthopaedic Surgeons.
2018;26(11):386-95.
17. Boureau F, Benad K, Putman S, Dereudre G, Kern G, Chantelot C. Does primary total knee arthroplasty for acute knee joint fracture maintain autonomy in the elderly? A retrospective study of 21 cases. Orthopaedics & Traumatology: Surgery & Research. 2015;101(8):947-51.
18. Ries MD. Primary arthroplasty for management of osteoporotic fractures about the knee. Current osteoporosis reports. 2012;10(4):322-7.
19. Bohm E, Tufescu T, Marsh J. The operative management of osteoporotic fractures of the knee: to fix or replace? The Journal of Bone and Joint Surgery British volume. 2012;94(9):1160-9.
20. Frattini M, Vaienti E, Soncini G, Pogliacomi F. Tibial plateau fractures in elderly patients. La Chirurgia degli organi di movimento. 2009;93(3):109-14.
21. Levy O, Salai M, Ganel A, Mazor J, Oran A, Horoszowski H. The operative results of tibial plateau fractures in older patients: a long-term follow-up and review. Bulletin (Hospital for Joint Diseases (New York, NY)). 1993;53(1):15-6.
22. Hsu CJ, Chang WN, Wong CY. Surgical treatment of tibial plateau fracture in elderly patients. Archives of orthopaedic and trauma surgery. 2001;121(1-2):67-70.
23. Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Soltani-Moghaddas SH. Cross-cultural adaptation and validation of the persian version of the oxford knee score in patients with knee osteoarthritis. Iranian journal of medical sciences. 2014;39(6):529.
24. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Quality of life research. 2005;14(3):875-82.
25. Doosti-Irani A, Nedjat S, Nedjat S, Cheraghi P, Cheraghi Z. Quality of life in Iranian elderly population using the SF-36 questionnaire: systematic review and meta-analysis. Eastern Mediterranean Health Journal. 2018;24(11).
26. Ali AM, Saleh M, Eastell R, Wigderowitz CA, Rigby AS, Yang L. Influence of bone quality on the strength of internal and external fixation of tibial plateau fractures. Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 2006;24(11):2080-6.
27. Cheung WH, Miclau T, Chow SK, Yang FF, Alt V. Fracture healing in osteoporotic bone. Injury. 2016;47 Suppl 2:S21-6.
28. Karpouzos A, Diamantis E, Farmaki P, Savvanis S, Troupis T. Nutritional aspects of bone health and fracture healing. Journal of osteoporosis. 2017;2017.
29. Holstein JH, Becker SC, Fiedler M, Scheuer C, Garcia P, Histing T, et al. Exercise enhances angiogenesis during bone defect healing in mice. Journal of Orthopaedic Research. 2011;29(7):1086-92.
30. Marques EA, Mota J, Carvalho J. Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. AGE. 2012;34(6):1493-515.
31. Shahrezaee M, Oryan A, Bastami F, Hosseinpour S, Shahrezaee MH, Kamali A. Comparative impact of systemic delivery of atorvastatin, simvastatin, and lovastatin on bone mineral density of the ovariectomized rats. Endocrine. 2018;60(1):138-50.
32. Oldroyd A, Dubey S. The association between bone mineral density and higher body mass index in men. International journal of clinical practice. 2015;69(1):145-7.
33. Hannan MT, Felson DT, Dawson‐Hughes B, Tucker KL, Cupples LA, Wilson PW, et al. Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. Journal of Bone and Mineral Research. 2000;15(4):710-20.
34. Greenstein AS, Gorczyca JT. Orthopedic Surgery and the Geriatric Patient. Clinics in geriatric medicine. 2019;35(1):65-92.
35. Honkonen SE. Degenerative arthritis after tibial plateau fractures. J Orthop Trauma. 1995;9(4):273-7.
36. Volpin G, Dowd GS, Stein H, Bentley G. Degenerative arthritis after intra-articular fractures of the knee. Long-term results. J Bone Joint Surg Br. 1990;72(4):634-8.
37. Wasserstein D, Henry P, Paterson JM, Kreder HJ, Jenkinson R. Risk of total knee arthroplasty after operatively treated tibial plateau fracture: a matched-population-based cohort study. J Bone Joint Surg Am. 2014;96(2):144-50.
38. Sarzaeem MM, Omidian MM, Kazemian G, Manafi A. Acute Primary Total Knee Arthroplasty for Proximal Tibial Fractures in Elderly. Arch Bone Jt Surg. 2017;5(5):302-7.
39. Sivasubramanian H, Kini SG, Ang KY, Sathappan S. Use of
tantalum cones in primary arthroplasty of acute proximal tibial fractures. Acta Orthop Belg. 2016;82(3):593-8.
40. Huang J-F, Shen J-J, Chen J-J, Tong P-J. Primary total knee arthroplasty for elderly complex tibial plateau fractures. Acta orthopaedica et traumatologica turcica. 2016;50(6):702-5.
41. Wong MT, Bourget-Murray J, Johnston K, Desy NM. Understanding the role of total knee arthroplasty for primary treatment of tibial plateau fracture: a systematic review of the literature. Journal of Orthopaedics and Traumatology. 2020;21:1-7.
42. Rademakers M, Kerkhoffs G, Sierevelt I, Raaymakers E, Marti R. Operative treatment of 109 tibial plateau fractures: five-to 27-year follow-up results. Journal of orthopaedic trauma. 2007;21(1):5-10.
43. Gerich T, Blauth M, Witte F, Krettek C. [Osteosynthesis of fractures of the head of the tibia in advanced age. A matched-pair analysis]. Der Unfallchirurg. 2001;104(1):50-6.
44. van Dreumel RL, van Wunnik BP, Janssen L, Simons PC, Janzing HM. Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures. Injury. 2015;46(8):1608-12.
45. Lachiewicz PF, Funcik T. Factors Influencing the Results of Open Reduction and Internal Fixation of Tibial Plateau Fractures. Clinical Orthopaedics and Related Research®. 1990;259.
46. Rommens PM. Paradigm shift in geriatric fracture treatment. European journal of trauma and emergency surgery : official publication of the European Trauma Society. 2019;45(2):181-9