The operative management of osteoporotic fractures of the knee

Abstract

This review considers the surgical treatment of displaced fractures involving the knee in elderly, osteoporotic patients. The goals of treatment include pain control, early mobilisation, avoidance of complications and minimising the need for further surgery. Open reduction and internal fixation (ORIF) frequently results in loss of reduction, which can result in post-traumatic arthritis and the occasional conversion to total knee replacement (TKR). TKR after failed internal fixation is challenging, with modest functional outcomes and high complication rates. TKR undertaken as treatment of the initial fracture has better results to late TKR, but does not match the outcome of primary TKR without complications. Given the relatively infrequent need for late TKR following failed fixation, ORIF is the preferred management for most cases. Early TKR can be considered for those patients with pre-existing arthritis, bicondylar femoral fractures, those who would be unable to comply with weight-bearing restrictions, or where a single definitive procedure is required.

Osteosynthesis or arthroplasty of fractures near the knee joint in geriatric patients – a clinical-economical comparison

“…Insgesamt können wir die Aussagen der Literatur bestätigen, dass die Frakturendoprothetik beim geriatrischen Krankengut bei definierten Indikationen mit einem besseren funktionellen Outcome und vergleichbarer oder sogar geringerer Komplikationsrate einhergeht [4].…”

Primary and Secondary Total Knee Arthroplasty for Tibial Plateau Fractures

“…Malviya et al 15 recommended stemmed cemented components because they are thought to confer primary stability, allowing early, unrestricted mobilization. Many other authors share this opinion, although Bohm et al 24 suggested that the surgeon might forgo the use of a stemmed tibial implant in the presence of good circumferential cortical support. Although most of the literature supports the use of cement, its effect on associated fracture union remains largely unknown ( Figure 1).…”

Primary Total Knee Arthroplasty (TKA) in Tibial Plateau Fractures

“…In Schatzker types I, II, and IV, the authors suggested using intramedullary fi xation, supplemented by internal fi xation if the fragments are large enough. Finally Schatzker type V and VI involving both condyles, with or without metaphyseal extension, are the most demanding to manage, and the authors suggested a combination of tibial stems and plate fi xation [ 4 ].…”

“…Some authors described an unacceptable failure rate (79 %) and unsatisfactory results for ORIF in elderly patients [ 1 ]. For these reasons there is still a concern about treating tibial plateau fractures in elderly patients using ORIF [ 4 ].…”