Pilon Fractures in Patients Older Than 60 Years of Age: Should We Be Fixing These?

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Geriatric Orthopedics

Background:

• Pilon fractures, also known as tibial plafond fractures, are complex injuries requiring surgical intervention.
• Outcomes in elderly patients undergoing operative treatment for pilon fractures are not well-established compared to younger populations.

Purpose of the Study:

• To compare the incidence of complications following operative treatment of pilon fractures between elderly (≥60 years) and younger (<60 years) patient groups.
• To determine if advanced age is an independent risk factor for surgical treatment failure in pilon fractures.

Main Methods:

• Retrospective comparative study of 538 patients with tibial plafond fractures (OTA/AO 43-B & 43-C) treated with open reduction-internal fixation (ORIF).
• Patients were divided into two groups: elderly (≥60 years) and younger (<60 years).
• Treatment failure was defined as nonunion or arthrosis. Statistical analyses included chi-square and regression analyses.

Main Results:

• No significant differences in treatment failure (43% vs. 37%), infection (10% vs. 13%), or malunion (3% vs. 4%) were observed between elderly and younger patients.
• Age >60 was not found to be an independent predictor of treatment failure (OR 1.2).
• Factors significantly associated with treatment failure included bone loss, open fracture, and malreduction.

Conclusions:

• Surgical treatment failure, defined as nonunion or arthrosis, is not independently predicted by age over 60 in patients with pilon fractures.
• Elderly patients can be treated similarly to younger patients using open reduction-internal fixation (ORIF) for pilon fractures.
• This study represents the largest cohort investigating pilon fractures in elderly patients, supporting continued similar treatment approaches.