Circular frame fixation of complex tibial plateau fractures in the elderly: Functional and radiological outcomes for Schatzker V and VI type fractures

Tibial plateau fracture fixation in the elderly poses a unique challenge due to poor bone stock, comminution and co-morbidities. There is limited evidence available in older patients sustaining multiple column Schatzker type V and VI injuries. In our institutions these injuries have traditionally been managed with circular frame fixation, often augmented with cross knee frame extension, internal screw fixation +/- bone graft substitutes. This study has reviewed the over 60-year-old cohort to better understand this complex injury. METHODS: Electronic fracture databases were queried for 'tibial plateau fracture' and 'Ilizarov frame' between July 2009 and 2019. Inclusion criteria; age >60 years; CT identified multiple column (Schatzker V or VI) injuries; Ilizarov fixation; adequate follow-up data. Patient demographics, fixation technique, time to frame removal, residual radiological tibial deformity, joint incongruity, significant peri‑operative complications and progression to salvage TKA were reported. RESULTS: 35 patients >60 years were treated with Ilizarov frame techniques for multiple column injuries. 84 % were female. Average age was 68 (62-81) with a follow-up of 6.6 years (2.3-11.3). 33 of the 35 patients investigated for osteoporosis had evidence of decreased bone mass (94 %). 94 % were Schatzker VI injuries. 22 cases required cross knee extension with a frame duration 155 days (range 103-317). Those without had a frame duration 128 days (range 93-212). 20 cases had a combined internal/external fixation technique and 9 cases required allograft or bone substitute. There was one case of non-union requiring salvage to constrained TKA. Three cases (9 %) of metalwork removal, two for prominent metalwork and one for deep infection. There were no VTE events and there was 0 % mortality in the two post-operative years. Oxford knee scores and SF-12 scores demonstrate that minimal residual deformities in the coronal and sagittal planes following frame removal are tolerated well within this age group. This study demonstrates Ilizarov techniques are highly successful at permitting early weight bearing and achieving union with associated low morbidity rates in an older population.