Osteosynthesis of tibial plateau fractures in the elderly - A matched-pair-analysis

In a retrospective study we analyzed 183 patients with tibial head fractures. 15 patients were older than 60 years at the time of accident, with a mean age of 69 (62-81) years. All patients had sustained an isolated tibial plateau fracture with a split-impression fracture in 10 patients, an impression fracture in 2 patients and a bicondylar fracture in 3 patients. The mean time to follow-up was 5.1 years. In a matched-pair-analysis this group was compared to a group of young patients with a mean age of 43 years (26-56) and identical lesions and surgical procedures. The mean time to follow-up in this group was 4.2 years. We observed that fractures at higher age resulted mostly from trivial accidents. Except from a prolonged inpatient time the initial course was comparable. In a 66 year-old woman early implant removal was necessary because of infection. Despite identical surgical treatment we observed a loss of reduction with incongruency of the plateau and deviation of the axis. Correspondingly older patients displayed a statistically significant threefold increase of osteoarthritis compared to younger patients. However,there was no clinical correlation using the Rasmussen, OAK and Lysholm score. Both groups displayed no statistical significant differences for the parameters function, stability and pain. According to the old age the only significant difference was a reduction of the Tegner score. Reduction and internal fixation of tibial plateau fractures in an elderly population displayed mostly a satisfactory clinical result within this 5-year period. The problem of loss of reduction and rapid osteoarthritis remains to be evaluated in a larger group over a longer period of time.