Pilon Fractures in Patients Older Than 60 Years of Age: Should We Be Fixing These?

OBJECTIVES: To compare complications after operatively treated pilon fracture between elderly patients (≥60 years) and younger patients (<60 years).

DESIGN: Retrospective comparative study.

SETTING: Two Level-1 academic trauma.

PATIENTS/PARTICIPANTS: Of the 740 tibial plafond fractures (OTA/AO 43-B & 43-C) treated January 2006 through December 2016, 538 patients had a minimum of 1 year follow up.

INTERVENTION: Open reduction-internal fixation (ORIF).

MAIN OUTCOME MEASUREMENT: Treatment failure defined as either nonunion or arthrosis.

RESULTS: A total of 72 patients comprised the elderly group (mean age 66 years) and 466 patients comprised the younger group (mean age 44 years) (P < 0.001). Besides significantly more tobacco use in the younger group, patient demographics and fracture characteristics did not differ. Locking plates were used significantly more in elderly patients (47% vs. 32%, P = 0.01). Using chi-square analysis, we were unable to detect a difference in treatment failure (elderly 43% vs. young 37%, P = 0.33), infection (elderly 10% vs. young 13%, P = 0.4), or malunion (elderly 3% vs. young 4%, P = 1.0). Using regression analysis, age >60 was not associated with treatment failure [odds ratio (OR) 1.2 (0.7-2.1), P = 0.52]. Bone loss (OR 2.7 [1.8-4.1], P < 0.001), open fracture (OR 1.6 [1-2.5], P = 0.03), and malreduction (OR 4.2 [2.5-7.3], P < 0.001) were associated with failure.

CONCLUSIONS: Age >60 years is not an independent predictor of surgical treatment failure of pilon fractures as defined by nonunion or arthrosis. This is the largest cohort of pilon fracture in elderly patients and indicates that we should continue to treat elderly patients similar to their younger counterparts using ORIF.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.