Poor Outcomes of Lateral Tibial Plateau Fractures in Women Aged 50 and Older: A Case Series

Background: This study assessed the long-term clinical outcomes of women (≥50 years of age) who undergo operative management of lateral tibial plateau fractures, with particular focus on risk of conversion to total knee arthroplasty (TKA). Materials and Methods: A retrospective review was conducted on female patients aged 50 and older who sustained lateral tibial plateau fractures treated with open reduction and internal fixation (ORIF) at a level 1 trauma center between January 2003 and July 2023. The primary outcome measure was conversion to TKA. Secondary outcome measures included lateral joint subsidence, arthrosis progression, surgical complications, and reoperations for any reason. Results: Forty-one women underwent ORIF of lateral tibial plateau fractures during the study period with an average age of 63.5 ± 9.0 years. The mechanism of injury for most patients was a ground-level fall (n = 24, 58.5%). At final follow-up, lateral joint subsidence was present in 22 women (53.7%), and patients progressed an average of 1.0 Kellgren-Lawrence grade in terms of arthrosis. A total of 7 women (17.1%) underwent conversion to TKA at a mean of 4.0 years after ORIF. Conclusion: Women 50 years and older demonstrated a 17.1% rate of conversion to TKA following operative management of laterally impacted tibial plateau fractures, more than two times higher than rates seen in the general population affected by these fractures. Appropriate counseling should be offered preoperatively for these patients.