title: Operative treatment of tibial plateau fractures in patients older than 55 years.
abstract: Surgical treatment of tibial plateau fractures in the older patient poses an additional challenge because of the underlying condition of the bone and articular surface. We sought to identify risk factors for poorer outcomes in the operative treatment of displaced tibial plateau fractures in older patients. Thirty-nine displaced tibial plateau fractures in patients 55 years and older were treated operatively. Patients were evaluated objectively with Rasmussen clinical and radiologic scoring techniques, and the Short Musculoskeletal Function Assessment and the Short-Form 36 self-assessment instruments. The Rasmussen clinical and radiologic scoring systems, used on average 2.54 years postoperatively, found acceptable results in 87.2% and 82.1% of patients, respectively. The fracture classification of Schatzker was not predictive of results. External fixation was associated with significantly poorer results. Increasing age was associated with poorer clinical and self-assessment scores, although preexisting degenerative joint disease was not. The results from the Short-Form 36 indices were not significantly worse for our study patients. The average Short Musculoskeletal Function Assessment score of our study patients indicated poorer function for mobility than a normative group. Operative treatment of this injury in this population can result in favorable outcomes as evaluated by clinical, radiographic, and self-assessment criteria.
authors.affiliation: Hospital for Special Surgery-Weill Medical College of Cornell University, New York City, NY 10021, USA.
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Su
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Westrich
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Rana
authors.forename: Komal
authors.initials: K
authors.lastname: Kapoor
authors.forename: David L
authors.initials: DL
authors.lastname: Helfet
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005592:Fracture Fixation; D006304:Health Status; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome