Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Gyeongchun 153, Guri, Gyeonggi-do, 11923, South Korea.
Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea.
Arch Orthop Trauma Surg. 2022 Oct;142(10):2419-2427. doi: 10.1007/s00402-021-03855-7. Epub 2021 Mar 10.
Several studies have reported that total knee arthroplasty (TKA) is a suitable solution to treat elderly patients with complex tibial plateau fractures. The purpose of the present study was to compare surgical treatment outcomes after open reduction internal fixation (ORIF) between elderly and younger patients.
We reviewed patients with plateau fracture (OTA/AO classification types 41B and 41C) who underwent ORIF at two academic trauma centers between November 2006 and October 2019. Of the 341 patients, 76 were ultimately included in the younger group (< 60 years old) and 77 in the elderly group (≥ 60 years). The average follow-up was 24 months (range 12-96 months). The primary outcome was any common complication of plateau fracture, namely post-traumatic arthritis and alignment change. Conversion to TKA, Reduction loss, coronal malalignment, non-union, union time, infection, and limb length discrepancy (LLD) were also assessed.
The elderly group had a significantly higher prevalence of diabetes, but there were no other significant differences between the groups in terms of patient demographics, fracture characteristics, and operation characteristics. We detected no differences between the groups in terms of post-traumatic arthritis (p = 0.216), alignment change (p = 0.093), conversion to TKA (p = 0.681), reduction loss (p = 0.079), coronal malalignment (p = 0.484), non-union rate (p = 0.719), infection (p = 0.063), LLD (p = 0.154), or time to union (p = 0.513). Logistic regression analysis revealed that age > 60 years was not associated with treatment failure, defined as either post-traumatic arthritis greater than grade II or non-union (p = 0.468). OTA/AO classification type 41C2 (p = 0.019), type 41C3 (p = 0.008), and malreduction (p = 0.050) were significant risk factors for failure.
Age ≥ 60 years is not an independent risk factor of poor radiographic outcome and high complication rate in tibial plateau fractures. This indicates that ORIF is still a good solution to treat elderly patients, similar to their younger counterparts.
多项研究表明，全膝关节置换术（TKA）是治疗老年复杂胫骨平台骨折患者的合适方法。本研究的目的是比较老年患者和年轻患者行切开复位内固定术（ORIF）后的手术治疗效果。
我们回顾了在 2006 年 11 月至 2019 年 10 月期间在两个学术创伤中心接受 ORIF 治疗的胫骨平台骨折（OTA/AO 分类 41B 和 41C 型）患者。在 341 例患者中，最终有 76 例纳入年轻组（<60 岁），77 例纳入老年组（≥60 岁）。平均随访时间为 24 个月（12-96 个月）。主要结局是胫骨平台骨折的任何常见并发症，即创伤后关节炎和对线改变。还评估了 TKA 转换、复位丢失、冠状面对线不良、不愈合、愈合时间、感染和肢体长度差异（LLD）。
老年组糖尿病的患病率明显较高，但两组在患者人口统计学、骨折特征和手术特征方面无其他显著差异。我们发现两组在创伤后关节炎（p=0.216）、对线改变（p=0.093）、TKA 转换（p=0.681）、复位丢失（p=0.079）、冠状面对线不良（p=0.484）、不愈合率（p=0.719）、感染（p=0.063）、LLD（p=0.154）或愈合时间（p=0.513）方面无差异。Logistic 回归分析显示，年龄>60 岁与治疗失败无关，定义为创伤后关节炎大于 II 级或不愈合（p=0.468）。OTA/AO 分类 41C2 型（p=0.019）、41C3 型（p=0.008）和复位不良（p=0.050）是失败的显著危险因素。
年龄≥60 岁不是胫骨平台骨折影像学结果差和并发症发生率高的独立危险因素。这表明 ORIF 仍然是治疗老年患者的一种较好的方法，与年轻患者相似。
