Sabatini Luigi, Aprato Alessandro, Camazzola Daniele, Bistolfi Alessandro, Capella Marcello, Massè Alessandro
University of Turin, Viale 25 aprile 137 int 6, Torino 10133, Italy.
University of Turin, Viale 25 aprile 137 int 6, Torino 10133, Italy.
Injury. 2023 Mar;54 Suppl 1:S15-S23. doi: 10.1016/j.injury.2021.02.006. Epub 2021 Feb 7.
Displaced proximal tibia fractures in the elderly may be very difficult to manage. If osteosynthesis represents the standard of care in the younger patients, in the aged population this solution is controversial because a significant failure rate has been reported after internal fixation. Moreover, osteoarthritis progression following tibial plateau fractures is common, often requiring a subsequent total knee arthroplasty (TKA). In recent years, in order to overcome the fracture healing problems and to allow immediate full weight bearing, primary TKA after tibial plateau fractures in elderly patients has gained popularity.
from 2015 to 2019, 11 tibial plateau fractures in elderly patients with pre-existing osteoarthritis were treated with a primary TKA. Age, gender, mechanism of trauma, pre-operative autonomy level, fractures classification, degree of osteoarthritis and intraoperative data (ligamentous stability and type of implant) were collected. After a mean follow-up of 28 months, Knee Society Score (KSS), post-operative autonomy level and Forgotten Joint Score (FJS) were evaluated. The radiological assessment (signs of loosening, limb axis and patellar height indices) and complications were also recorded.
according to fracture type and ligamentous competence, 6 cases of posterior-stabilized (PS) design and 5 cases of semi-constrained TKA were implanted. At the final follow up, mean KSS knee score was 83±16 and mean KSS functional score was 74±15. Mean pre-operative autonomy level assessed with the Parker scale, was significantly higher than the post-operative one (7.5±1.4 vs 5.6 ± 1.3). Mean FJS was 66 ± 14. No lines of radiolucency or limb malalignment were found at the final radiological follow-up. One major complication was recorded: one acute periprosthetic infection. One patient reported a periprosthetic femoral fracture after 26 months.
Based on our and results and those reported on literature, primary TKA is a suitable option in case of tibial plateau fractures in elderly patients with pre-existing osteoarthritis and poor bone quality, in which osteosynthesis outcome may be poor. Unlike ORIF, primary TKA may allow immediate weightbearing and a faster recovery. Nevertheless, it is a demanding surgery with a significant complications rate and should be reserved for selected patients and experienced surgeons.
老年患者的胫骨近端移位骨折可能极难处理。如果在年轻患者中接骨术是标准治疗方法，那么在老年人群中，这种解决方案存在争议，因为据报道内固定后有显著的失败率。此外，胫骨平台骨折后骨关节炎进展很常见，通常需要后续进行全膝关节置换术（TKA）。近年来，为了克服骨折愈合问题并允许立即完全负重，老年患者胫骨平台骨折后一期TKA越来越受欢迎。
2015年至2019年，对11例患有原发性骨关节炎的老年患者的胫骨平台骨折进行了一期TKA治疗。收集了年龄、性别、创伤机制、术前自主水平、骨折分类、骨关节炎程度和术中数据（韧带稳定性和植入物类型）。平均随访28个月后，评估膝关节协会评分（KSS）、术后自主水平和遗忘关节评分（FJS）。还记录了放射学评估（松动迹象、肢体轴线和髌骨高度指数）及并发症。
根据骨折类型和韧带功能，植入了6例后稳定（PS）设计的TKA和5例半限制性TKA。在最后一次随访时，平均KSS膝关节评分为83±16，平均KSS功能评分为74±15。用帕克量表评估的术前平均自主水平显著高于术后（7.5±1.4对5.6±1.3）。平均FJS为66±14。在最后一次放射学随访中未发现透光线或肢体排列不齐。记录了1例主要并发症：1例急性假体周围感染。1例患者在26个月后发生假体周围股骨骨折。
根据我们的结果以及文献报道，对于患有原发性骨关节炎且骨质较差的老年患者的胫骨平台骨折，一期TKA是一种合适的选择，在这些患者中接骨术的效果可能较差。与切开复位内固定术（ORIF）不同，一期TKA可允许立即负重并更快恢复。然而，这是一项要求较高的手术，并发症发生率较高，应仅适用于选定的患者和经验丰富的外科医生。
