Conservative Management of Varus/Valgus Stable Tibial Plateau Fractures in Osteoporotic Bone – Preliminary Results and Considerations

Objectives: While operative fixation is the current recommendation for treating significantly displaced tibial plateau fractures (DTPFs) in elderly patients, our research suggests that non-operative management may also be a viable option as the primary treatment for these individuals. Our study aimed to evaluate the clinical outcomes of patients with complex DTPFs who received non-operative management as their primary management. Methods: Our study involved a retrospective analysis of non-operatively treated DTPFs during the period of 2019 to 2020. We included all patients for the evaluation of fracture healing and range of motion (ROM). Additionally, we conducted functional outcome assessments on all patients, utilizing the Oxford Knee Score (OKS) both before their injury and at the 10-month mark after their injury. Results: The study included 10 patients, comprising two males and eight females, with a mean age of 62.9 years (range: 46-74). Among them, four patients had Schatzker Type III DTPFs, two had Type V, and four had Type VI. Non-operative management was administered using hinged-knee braces, and patients progressed to weight-bearing gradually, with a minimum follow-up period of 10 months. The average time to bone union was 4.3 months (range: 2-7). The mean Oxford Knee Score (OKS) after the injury was 38.8 (range: 23-45), with an average reduction of 16.9% (p = 0.003). The average fracture depression was 11.41 mm (range: 4.2-29), and the average fracture split was 14.03 mm (range: 5.5-44). Conclusion: Based on our study, it appears that elderly patients with significantly displaced tibial plateau fractures (DTPFs) can be treated non-operatively as their primary management, despite the current consensus suggesting otherwise.