Geriatric tibial plateau fractures: A multicenter analysis of complications and treatment strategies.

Abstract

Tibial plateau fractures are among the most complex periarticular injuries and pose a significant therapeutic challenge, particularly in geriatric patients, due to compromised bone quality, comorbidities, and limited mobility. Against the backdrop of demographic change, this multicenter study aims to analyze complications, risk factors for revision surgery, and treatment strategies for geriatric tibial plateau fractures. A retrospective cohort study was conducted at two supraregional trauma centers. Patients aged ≥ 70 years with surgically treated intra-articular tibial plateau fractures (AO/OTA 41-B/C) between 2010 and 2022 were included. Demographic parameters, fracture morphology, complications, risk factors, and surgical treatment were recorded. Statistical analyses were performed using chi-square tests and t-tests (significance p ≤ 0.05). 148 patients were included (75% female; mean age 76.4 ± 5.3 years). Postoperative complications occurred in 36 patients (24.3%). Wound healing disorders (7.4%), deformities (6%), and infections (5.4%) were the most frequent. Classic risk factors showed no significant association with complications. Schatzker type VI fractures had the highest complication rate at 44.2%. Longer surgery times and the use of an external fixator were significantly associated with complications. N = 9 (6.1%) patients were treated with primary total knee arthroplasty (TKA). In this group the complication rate was 22.2% (n = 2). Combinations of plate and screw osteosynthesis, as well as external fixators, showed the highest complication rates. Fracture morphology and surgical complexity were the factors most strongly associated with postoperative complications. Classic patient-related risk factors played a subordinate role. Given limited weight-bearing capacity, reduced bone quality, and restricted mobilization, stable, minimally invasive reconstruction should be the goal in geriatric patients. Primary TKA can be beneficial in highly complex, non-reconstructible fractures, but requires strict indications. In geriatric tibial plateau fractures, fracture morphology and surgical complexity appear to be the main factors associated with complications. Open reduction and internal fixation (ORIF) remain the standard of care if stable reconstruction is achievable; the indication for primary TKA should be limited to selected cases.