Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th Street, New York, NY, 10003, USA.
Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY, USA.
Eur J Orthop Surg Traumatol. 2023 Jul;33(5):2011-2017. doi: 10.1007/s00590-022-03384-y. Epub 2022 Sep 17.
The purpose of this study was to compare outcomes following surgical treatment of tibial plateau fractures in an elderly (≥ 65y) and non-elderly (< 65) population.
Patients with tibial plateau fractures were prospectively followed. Patients were included if they were operatively treated, had an Injury Severity Score of < 16, and had follow-up through 12 months. Clinical, radiographic, and functional outcomes were evaluated at the 3, 6, and 12-month follow-up points.
Mean time to radiographic fracture union was by 4.68 and 5.26 months in young and elderly patients, respectively (p = 0.25). There was no difference in self-reported baseline SMFA (p = 0.617). SMFA scores were better in younger patients at 3 months (p = 0.031), however this did not hold when multivariate modeling controlled for other factors. There was no difference at 6 and 12 months (p = 0.475, 0.392). There was no difference in range of knee motion at 3 months. At 6 and 12 months, young patients had statistically but not clinically better range of knee motion (p = 0.045, 0.007). There were no differences in overall reoperation rates, conversion arthroplasty, post-traumatic osteoarthritis or wound complications.
Age greater than 65 does not appear to portend poorer outcomes after surgical repair of a tibial plateau fracture. The complication profiles are similar. Elderly and younger patients had similar function at 12 months compared to their baseline. These data suggest that age should not be a disqualifying factor when considering whether a patient with a tibial plateau fracture should be treated operatively.
本研究旨在比较老年(≥65 岁)和非老年(<65 岁)人群接受手术治疗胫骨平台骨折的结果。
前瞻性随访胫骨平台骨折患者。纳入标准为手术治疗、损伤严重程度评分<16 分且随访至 12 个月的患者。在 3、6 和 12 个月的随访点评估临床、影像学和功能结果。
年轻患者和老年患者的影像学骨折愈合平均时间分别为 4.68 和 5.26 个月(p=0.25)。基线 SMFA 自评无差异(p=0.617)。年轻患者在 3 个月时 SMFA 评分更好(p=0.031),但在多变量模型控制其他因素后这一差异不再存在。6 个月和 12 个月时无差异(p=0.475、0.392)。膝关节活动度无差异 3 个月。在 6 个月和 12 个月时,年轻患者的膝关节活动度具有统计学意义但无临床意义上的改善(p=0.045、0.007)。总体再次手术率、转换关节成形术、创伤后骨关节炎或伤口并发症无差异。
年龄大于 65 岁似乎不会预示胫骨平台骨折手术后结果较差。并发症谱相似。与基线相比,老年和年轻患者在 12 个月时的功能相似。这些数据表明,在考虑是否对胫骨平台骨折患者进行手术治疗时,年龄不应成为排除因素。