Treatment of displaced bicondylar tibial plateau fractures (OTA-41C2&3) in patients older than 60 years of age

Objective: To investigate the outcome (clinical, radiographic, and general health status) of the surgical treatment of displaced bicondylar tibial plateau fractures (OTA-41C) in patients >60 years old. Design: Prospective cohort study. Setting: Limb reconstruction service, university teaching hospital. Patients: Eleven consecutive patients >60 years old with a mean age of 72 years (range 60 to 90 years). The indications for surgery were displaced bicondylar tibial fractures, open fractures, and fractures with severe soft tissue injury. Intervention: All patients were treated according to a standard protocol, which involved limited articular reconstruction and percutaneous intrafragmentary screw fixation, followed by neutralization with a stable beam-loading external fixator and early mobilization. Main Outcome Measurements: The clinical outcome was assessed using Rasmussen's system and the Iowa knee score. For general health assessment, the anglicized SF-36 was used. Radiographic assessment was performed for redisplacement and angulation on digitized radiographs. Results: After a mean follow-up of 38 months (range 18 to 51 months), bony union was achieved in all patients. Seven of 11 patients started full weight bearing 2 to 6 weeks postoperatively. According to Rasmussen's system, 9 of 11 (82%) scored satisfactory results. Radiographic redisplacement was found in three severely comminuted cases resulting in greater than or equal to10degrees of valgus malunion. One patient received a corrective osteotomy while still in the fixator. Another needed TKA. Limited knee flexion was found in three patients with cross knee fixation. Superficial pin site infection occurred in five patients, but there were no cases of deep infections or septic arthritis. Conclusions: All-ring external fixation, as a beam-loading system applied in a neutralizing mode, is a safe, stable, and reliable technique for the treatment of displaced bicondylar tibial plateau fractures in elderly patients.