A viable option for immediate mobilisation: Primary total knee replacement with supplementary osteosynthesis for acute complex tibial plateau fracture in elderly

Abstract

The principle of periarticular fracture is well established. However, the gold standard in treating tibial plateau fracture remains controversial. Lack of adequate soft tissue and complexity of the fracture involved succumbs to poor postoperative outcomes and high complication rate for infection, implant failure and non-union. Furthermore, the treatment of the elderly complicates the decision. It is because time is an essence since decubitus complication is associated with prolonged immobilisation. In addition, other complication related to this fracture such as accelerated secondary osteoarthritis and pain leads to further immobilisation. Traditionally, secondary total knee replacement (TKR) is indicated for this type of fracture, while the initial aim is to achieve bone healing. However, its failure related complication, the detrimental challenge in addressing ligament balance, extensor mechanism scarring and patella mal-tracking, thus, it is not commonly practised. The author has successfully demonstrated the use of primary TKR with supplementary locking plate in a post-traumatic Schatzker V tibial plateau fracture in a 75-year-old gentleman to allow immediate weightbearing. Thus, removing the complication associated with immobilisation and exhibit the advantage of TKR in obtaining a painless functional knee. In successive follow-up shows a favourable outcome and improved functional knee outcome compared to the premorbid state.