Program Director of Physical Medicine and Rehabilitation Memorial Hospital South Hollywood, Florida, United States
Case Diagnosis: Multiple trauma, Bilateral tibial plateau fractures
Case Description: We present an 88 year old female with past medical history of osteoarthritis of the right knee, osteoporosis, and glaucoma. She presented following multiple traumas after MVC. Her injuries most notably included right lateral tibial plateau fracture and left comminuted medial tibial plateau fracture with left knee lipohemarthrosis. She underwent right tibial ORIF. She also underwent closed treatment to the left tibia with left total knee arthroplasty. While she remained TTWB to her RLE, she was WBAT to her LLE with aggressive left knee ROM without restriction or bracing. Upon discharge she achieved minimum assist for transfers and supervision for wheelchair ambulation. She did not attempt walking while in acute rehabilitation due to weight bearing restrictions.
Discussions: Our case demonstrates two separate approaches to similar fractures in one patient. While the mainstay of tibial plateau fractures remains ORIF, closed treatment with knee arthroplasty is a treatment modality that is gaining popularity in elderly patients with poor bone stock. ORIF in tibial plateau fractures has a well known sequela of post traumatic arthritis, often requiring arthroplasty as a salvage method, even when ORIF is successful. To this effect, knee arthroplasty following closed treatment is gaining popularity in elderly patients at high risk for osteopenia. Our patient did not attempt ambulation due to weight bearing restrictions. However, within three weeks of discharge, her weight bearing status RLE was upgraded to 50%, and she was referred to ambulatory PT for further gait training.
Conclusions: Total knee arthroplasty is a second modality of surgical management in patients with tibial plateau fractures at high risk for post traumatic arthritis. This alternate to the current standard of care can avoid post operative complications and expedite gain in functional status for patients who otherwise could require further surgery following ORIF.