Pilon Fractures in Patients Older Than 60 Years of Age: Should We Be Fixing These?
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
pubmed:
17
12
2019
medline:
22
6
2021
entrez:
17
12
2019
Statut:
ppublish
Résumé
To compare complications after operatively treated pilon fracture between elderly patients (≥60 years) and younger patients (<60 years). Retrospective comparative study. Two Level-1 academic trauma. Of the 740 tibial plafond fractures (OTA/AO 43-B & 43-C) treated January 2006 through December 2016, 538 patients had a minimum of 1 year follow up. Open reduction-internal fixation (ORIF). Treatment failure defined as either nonunion or arthrosis. A total of 72 patients comprised the elderly group (mean age 66 years) and 466 patients comprised the younger group (mean age 44 years) (P < 0.001). Besides significantly more tobacco use in the younger group, patient demographics and fracture characteristics did not differ. Locking plates were used significantly more in elderly patients (47% vs. 32%, P = 0.01). Using chi-square analysis, we were unable to detect a difference in treatment failure (elderly 43% vs. young 37%, P = 0.33), infection (elderly 10% vs. young 13%, P = 0.4), or malunion (elderly 3% vs. young 4%, P = 1.0). Using regression analysis, age >60 was not associated with treatment failure [odds ratio (OR) 1.2 (0.7-2.1), P = 0.52]. Bone loss (OR 2.7 [1.8-4.1], P < 0.001), open fracture (OR 1.6 [1-2.5], P = 0.03), and malreduction (OR 4.2 [2.5-7.3], P < 0.001) were associated with failure. Age >60 years is not an independent predictor of surgical treatment failure of pilon fractures as defined by nonunion or arthrosis. This is the largest cohort of pilon fracture in elderly patients and indicates that we should continue to treat elderly patients similar to their younger counterparts using ORIF. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 31842187
doi: 10.1097/BOT.0000000000001661
pii: 00005131-202003000-00002
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
121-125Références
Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures: variables contributing to poor results and complications. Clin Orthop Relat Res. 1993:108–117.
Ovadia DN, Beals RK. Fractures of the tibial plafond. J Bone Joint Surg. 1986;68:543–551.
Duckworth AD, Jefferies JG, Clement ND, et al. Type C tibial pilon fractures: short- and long-term outcome following operative intervention. Bone Joint J. 2016;98B:1106–1111.
Chan DS, Balthrop PM, White B, et al. Does a staged posterior approach have a negative effect on OTA- 43C fracture outcomes? J Orthop Trauma. 2017;32:90–94.
Sirkin M, Sanders R, DiPasquale T, et al. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 1999;13:78–84.
Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma. 1999;13:85–91.
Haller JM, Githens M, Rothberg D, et al. Risk factors for tibial plafond nonunion: medial column fixation may reduce nonunion rates. J Orthop Trauma. 2019;33:443–449.
Kottmeier SA, Madison RD, Divaris N. Pilon fracture: preventing complications. J Am Acad Orthop Surg. 2018;26:640–651.
Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 suppl):S1–S133.
Bhandari M, Guyatt G, Tornetta P III, et al. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008;90:2567–2578.
Marsh JL, Weigel DP, Dirschl DR. Tibial plafond fractures: how do these ankles function over time? J Bone Joint Surg Am. 2003;85-A:287–295.
Marsh JL, Bonar S, Nepola JV, et al. Use of an articulated external fixator for fractures of the tibial plafond. J Bone Joint Surg. 1995;77:1498–1509.
Davidovitch RI, Elkhechen RJ, Elkataran R, et al. Open reduction with internal fixation versus limited internal fixation and external fixation for high grade pilon fractures (OTA type 43C). Foot Ankle Int. 2011;32:955–961.
Haller JM, O'Toole R, Graves M, et al. How much articular displacement can be detected using fluoroscopy for tibial plateau fractures? Injury. 2015;46:2243–2247.
Barei DP, Nork SE, Mills WJ, et al. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am. 2006;88:1713–1721.