The angled blade plate has been the historical standard in fixed-angle extramedullary subtrochanteric femur fracture fixation, but it requires an extensile lateral approach to the femur. Little formal evaluation exists for specifically designed percutaneous extramedullary implants. The purpose of this study was to compare 3 locked plating constructs, all with percutaneous insertion capability, with the standard 95-degree angled blade plate to determine whether specifically designed fixed-angle extramedullary implants for subtrochanteric femur fractures were biomechanically comparable to the angled blade plate. Forty composite adult femurs were divided into 4 equal groups. The constructs evaluated included a 95-degree angled blade plate, a broad 4.5-mm combination locking plate, and a precontoured proximal femoral locking plate (PFLP) with and without an oblique, angled strut or "kickstand" screw. A 30-degree wedge osteotomy was used to create a subtrochanteric fracture gap model. Each specimen underwent axial and torsional stiffness testing along with cyclic axial loading to failure. Axial stiffness testing revealed that the PFLP with the "kickstand" screw was the stiffest construct (92.2 +/- 17.4 Nm/m), which was 211% stiffer than the blade plate, 309% stiffer than the broad plate, and 194% stiffer than the PFLP without the kickstand screw. The blade plate had the highest torsional stiffness (2.42 +/- 0.08 Nm/degree), which was 151% stiffer than the broad plate, 128% stiffer than the PFLP with the kickstand, and 138% stiffer than the PFLP without the kickstand screw. The PFLP with the kickstand screw had the least irreversible deformation (6.3 mm), which was 52% less than the broad plate and 61% less than the PFLP without the kickstand screw. Our data reveal that the PFLP with the "kickstand" screw provides more axial stiffness, less torsional stiffness, and equivalent irreversible deformation to cyclic axial loading when compared with the blade plate.

Tibial plateau fractures account for approximately 8% of fractures in the elderly population. Treatment strategies in the elderly are similar to those for younger patients; however, practitioners must account for the elevated comorbidity burden in this population. To date, few studies have analyzed age-based outcomes in patients with tibial plateau fractures. Therefore, the purpose of this study was to determine age-related variances in demographics, fracture characteristics, mechanism of injury, and complications. A 10-year retrospective review was conducted to identify patients who received treatment for a tibial plateau fracture. There were 351 patients (360 tibial plateau fractures) who were identified and subsequently stratified according to their age at the time of injury. Patients were classified as elderly if they were 65 years of age or older at the time of injury; all other patients were included in the control cohort. These two cohorts were analyzed using bivariate analysis to isolate for age-related variations with respect to risk factors, mechanism of injury, and complications. There were 351 patients (360 tibial plateau fractures) with a median follow-up of 1.84 ± 2.44 years who met inclusion criteria. There were a greater proportion of women in the elderly cohort as compared with the younger cohort (60.0 vs. 43.4%, p = 0.06). Elderly patients were significantly more likely to present with diabetes (33.3 vs. 16.1%, p = 0.01) or osteoporosis (14.3 vs. 1.6%, p = 0.001). Younger patients were significantly more likely to require further surgery to address ligament (12.6 vs. 0%, p = 0.008), meniscus (20.9 vs. 7.1%, p = 0.036), or cartilage pathology (13.6 vs. 0%, p = 0.005). There was no difference in the arthroplasty conversion rate (4.8% elderly vs. 7.9% control, p = 0.755). While elderly patients presented with a greater comorbidity burden, they had equivalent or better short-term outcomes when compared with their younger peers when treated with open reduction and internal fixation (ORIF). Despite the recent interest in primary total knee arthroplasty for elderly patients with tibial plateau fractures, the results of this study suggest that elderly patients may respond well when treated with ORIF following a tibial plateau fracture.