Abstract
Objectives:
Tibial plateau fractures are complex knee joint injuries whose incidence is increasing, particularly among older patients. However, it remains unclear whether surgical treatment in geriatric patients leads to higher complication rates due to reduced bone quality and multimorbidity.
Methods:
In a retrospective analysis of 1,029 surgically treated patients (2011–2020) from two level-I trauma centers, three patient groups were formed: younger patients Group 1 (n=819; age 16–64 years), older patients Group 2 (n=133; age 65–79 years), and geriatric patients Group 3 (n=77; age ≥80 years or >70 years with ASA III). These groups were compared regarding postoperative complications requiring revision (e.g., wound healing disorders, infections, deformities) as well as fracture type (Schatzker and AO/OTA classification), operation time, and patient-specific factors (e.g., BMI, smoking status).
Results:
In Group 1 (mean age = 44.9 years), the overall complication rate was 28.8% (n=236). The most frequent complications were infections (23.3%), deformities (17.8%), and range of motion (ROM) deficits (15.7%). In Group 2 (mean age = 70.6 years), the overall complication rate was 18.8% (n=25). The most common complications were deformities (28.0%; n=7), wound healing disorders (20.0%; n=5), and infections (20.0%; n=5). No ROM deficits were observed in this age group. Among the geriatric patients (mean age = 79.2 years), postoperative complications occurred in 26.0% (n=20). The predominant complication was wound healing disorder (n=7; 35.0%). Across the entire patient cohort, complex fractures—especially Schatzker types IV–VI—were associated with higher complication rates compared to simpler fractures (Schatzker I–III). Additionally, across all groups, prolonged operation time was significantly associated with increased complication rates (p<0.05).
Conclusion:
The complication rate among geriatric patients is not higher compared to younger patient groups; however, the overall postoperative complication rate remains substantial. These findings emphasize the need for optimized perioperative management in patients with tibial plateau fractures, particularly in light of the notable frequency of wound healing disorders and infections. To derive changes in treatment strategies for elderly patients, additional factors such as postoperative mobility and functional outcomes must be considered.