Primary total knee replacement for tibial plateau fractures in older patients: a systematic review of 197 patients.

INTRODUCTION: Tibial plateau fractures are typically treated with osteosynthesis. In older patients, osteosynthesis is associated with some complications, risk of post-traumatic osteoarthritis and long partial, or non-weight bearing during the recovery phase. To avoid these problems, primary total knee replacement (TKR) has become an increasingly common treatment option. The aim of this study was to evaluate all the relevant literature and summarize the current evidence-based knowledge on the treatment of tibial plateau fractures with primary TKR in older patients. MATERIALS AND METHODS: A systematic literature search of studies on total knee replacement (TKR) as primary treatment for acute traumatic tibial plateau fracture was conducted using OVID Medline, Scopus, and Cochrane databases from 1946 to 18 November 2019. We included all studies without restrictions regarding total knee replacement (TKR) as primary treatment for acute traumatic tibial plateau fracture. RESULTS: Of the 640 reviewed articles, 16 studies with a total of 197 patients met the inclusion criteria. No controlled trials were available, and the overall quality of the literature was low. The results, using different clinical scoring systems, were good or fair. Four-year follow-up complication (6.1%) and revision (3.6%) rates after primary TKR appeared to be lower than after secondary TKR (complication rate 20-48%, revision rate 8-20%) but higher than after elective primary TKR. CONCLUSION: Based on low-quality evidence, TKR appears to be a useful treatment option for tibial plateau fractures in older patients. Controlled trials are mandatory to determine the relative superiority of these two options as primary treatment of tibial plateau fractures in older patients.

Pathophysiology, assessment, and treatment of Parkinson's disease.

Parkinson's disease (PD) is a slowly progressing neurologic movement disorder affecting nearly 1% of the population over age 65. PD is the fourth most common neurodegenerative disease of patients. Incidence is greater in men with a ratio of 3:2--men to women. Because PD is so complex, diagnosis and treatment are often very challenging. While the cause of PD is unknown, research has concentrated on genetics, exogenous toxins, and endogenous toxins from cellular oxidative reactions. The presenting symptoms of a patient with PD include muscle rigidity, tremors, bradykinesia, and postural instability. Treatment for PD has been primarily pharmacologic: levodopa, carbidopa, anticholinergics, and selegiline (a monoamine oxidase inhibitor to reestablish an equilibrium between dopamine and acetylcholine). surgical procedures (e.g., pallidotomy, thalamotomy, and tissue implants) are a possible choice of treatment for patients who have failed to respond satisfactorily to drugs.