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From the age of 50 the risk of fracture during the remaining years of life is estimated to be 40% in women and 20% men. The management of a fracture in the elderly is complex for several reasons, including decreased bone strength, a frequent association with previous joint replacement surgery or another orthopaedic implant, a high risk for anesthesia, difficulty in following postoperative recommendations, and an increased postoperative mortality. This article offers a review of fractures around the knee: distal femur, proximal tibia, patella and periprosthetic fractures. The vast majority of these fractures are treated surgically. When surgery is indicated, treatment should be initiated as soon as possible according to the patient's general condition in order to minimize the risk of complications and deconditioning.

In humans, the erect position and bipedal walk is possible because of a balance between pelvic and spinal parameters. The most important pelvic parameter is the pelvic incidence which represents the base on which the spine lies. With aging, thoracic kyphosis increases, lumbar lordosis decreases, compromising the spino-pelvic balance. Compensatory phenomenons are possible, but rely mostly on the amplitude of pelvic incidence. Analysis of spino-pelvic parameters and detection of a compensated or uncompensated sagittal imbalance are mandatory before any therapeutic action is undertaken for a degenerative pathology of the spine.