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. 2016 Sep;7(3):126-34.
doi: 10.1177/2151458516651310. Epub 2016 Jun 6.

Tibial Plateau Fractures in Elderly Patients

Joshua C Rozell  1 , Krishna C Vemulapalli  2 , Joshua L Gary  2 , Derek J Donegan  1
Affiliations

Tibial Plateau Fractures in Elderly Patients

Joshua C Rozell et al. Geriatr Orthop Surg Rehabil. 2016 Sep.

Abstract

Tibial plateau fractures are common in the elderly population following a low-energy mechanism. Initial evaluation includes an assessment of the soft tissues and surrounding ligaments. Most fractures involve articular depression leading to joint incongruity. Treatment of these fractures may be complicated by osteoporosis, osteoarthritis, and medical comorbidities. Optimal reconstruction should restore the mechanical axis, provide a stable construct for mobilization, and reestablish articular congruity. This is accomplished through a variety of internal or external fixation techniques or with acute arthroplasty. Regardless of the treatment modality, particular focus on preservation and maintenance of the soft tissue envelope is paramount.

Keywords: elderly; osteoporosis; tibial plateau fracture.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Select axial (A), coronal (B), and sagittal (C) cut of a computed tomography scan, showing a comminuted, intraarticular tibial plateau fracture.
Figure 2.
Figure 2.
A, Intraoperative anteroposterior and lateral fluoroscopic images following external fixation of a depressed, length unstable tibial plateau fracture, showing improved alignment compared with preoperative radiographs (B).
Figure 3.
Figure 3.
Anteroposterior (A) and lateral (B) radiographs and coronal CT (C) images of a 60-year-old male who sustained a Schatzker II tibial plateau fracture after a fall from standing. Note the degree of articular depression better appreciated on CT scan. CT indicates computed tomography.
Figure 4.
Figure 4.
Postoperative anteroposterior (A) and lateral (B) radiographs of a patient who underwent an anterolateral approach to the tibia for a Schatzker III tibial plateau fracture. Postoperative anteroposterior (C) and lateral (D) radiographs of an osteoporotic 74-year-old female with a prior distal femur fracture who sustained a Schatzker VI tibial plateau fracture and underwent a dual incision approach to support the medial and lateral columns.
Figure 5.
Figure 5.
A, Intraoperative fluoroscopic images using Kirschner wires and femoral distraction to obtain provisional fixation before applying lateral tibial plate (B).
Figure 6.
Figure 6.
Preoperative anteroposterior (A) and lateral (B) radiographs of a 62-year-old male with preexisting right knee osteoarthritis who sustained a lateral tibial plateau split depression fracture after a fall. He underwent an acute total knee arthroplasty with supplemental screw fixation. Postoperative anteroposterior (C) and lateral (D) images.
See this image and copyright information in PMC

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