Abstract
Fractures in the elderly population are a major increasing issue for any healthcare institution, associated with the growing life expectancy. Proximal tibial fractures affect the metaphyseal bone with or without articular extension, in 5 to 11% of all tibia fracture. Treatment options such as plate fixation, intramedullary nailing or even primary total knee arthroplasty are accepted valuable options. However, specific age-related risk factors such as osteoporosis, arthritis, multiple comorbidities and soft-tissue impairment shall also be taken in consideration as they may lead to severe complications if not fully understood. Therefore, a hybrid tibio-tibial external fixator may be considered as a valid surgical option for primary and definitive treatment care of these fractures especially if associated with soft-tissue damage. We report a retrospective observational analysis of three cases of closed extra-articular proximal tibia fractures associated with soft-tissue impairment in a geriatric population and treated with a hybrid external fixator (TenXor, Stryker). The fractures were classified according to the AO, as metaphyseal fractures (AO 41A2.1, 41A3.3). The post-operative protocol was standardized, with immediate full weight bearing. Complete consolidation of the fractures was obtained at 6 months. There were no pin tract infection and removal of the material has been done at 6 months. No cut-out of the proximal tibial wires was observed. The primary and definitive care of proximal tibial fractures by a hybrid external fixator appears to be a valuable surgical option in geriatric patients especially when associated with poor soft tissue coverage. The major advantage of this technique, acknowledging the longer bone consolidation process, is to avoid additional insult to the soft tissues. This surgical option gathers further treatment perspectives in the elderly population especially in cases of soft tissue limitations.
Highlights
The management of fractures in the elderly population is currently becoming a major public health issue, given the increasing life expectancy [1]
We report a clinical series of three geriatric patients admitted for fractures of the proximal tibia associated with soft tissue impairment, treated with hybrid tibio-tibial external fixator as a definitive treatment
Because early knee motion is mandatory for postoperative recovery, specific external fixation systems have gradually found their place in the range of possible treatment options [25]
Summary
The management of fractures in the elderly population is currently becoming a major public health issue, given the increasing life expectancy [1]. Fractures of the proximal tibia account for only 5 to 11% of all tibia fractures [2] These are typically epiphyseal, including intra-articular extension, or metaphyseal, which are much less common [3]. The implantation of a primary total knee replacement is an option, providing acceptable functional result [9]. All these techniques can lead to severe complications, especially in elderly people with multiple comorbidities and specific risk factors, such as soft-tissue fragility or osteoporosis [10, 11]. We report a clinical series of three geriatric patients admitted for fractures of the proximal tibia associated with soft tissue impairment, treated with hybrid tibio-tibial external fixator as a definitive treatment
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