Tibial plateau fractures in the older patient

The epidemiology and management of 151 tibial plateau fractures in patients aged over 60 years of age were reviewed. There were 115 females and 36 males. The usual mode of injury was a simple fall (88 fractures, 58%). The most common pattern of injury observed was the split depression variety, which accounted for 48 (32%) cases, followed by central depression fractures, which occurred in 31 (20%) cases. Non-operative management was used in 103 (68%) of fractures, open reduction and internal fixation in 40 (26%) fractures and external fixation in 8 (5%) fractures. Functional outcome in 67 patients assessed by the Hohl plateau evaluation score was similar in all 3 groups and was more closely related to initial fracture pattern. Forty-six (68%) of these 67 patients had evidence of osteoarthritic change on follow-up radiographs, but only 2 patients in the entire series went on to have a knee replacement. Degenerative change and a mediocre functional outcome are a common occurrence following tibial plateau fractures in patients over 60 years of age.