Determinants of functional recovery after tibial plateau fractures: The role of fracture severity, fixation, and complexity
Abstract
Objective: Tibial plateau fractures are complex intra-articular injuries with variable functional outcomes. While fracture classifications guide management, their ability to predict recovery remains unclear. This study evaluated the impact of fracture severity, treatment variables, and fracture complexity on patient-reported and objective outcomes over time. Methods: A retrospective cohort of 75 patients who underwent surgical treatment for tibial plateau fractures was analyzed. Functional outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and knee flexion at 1 month, 3 months, 6 months, 1 year, and 2 years postoperatively. Fractures were classified using Schatzker and AO/OTA systems. Fixation method, column and segment involvement, and patient factors were recorded. Longitudinal changes were analyzed using generalized estimating equations, and predictors of early improvement were evaluated using robust regression. Results: KOOS and knee flexion improved significantly over time (p<0.001). Mean KOOS increased from 23.15±5.87 at 1 month to 84.19±8.74 at 2 years, while flexion improved from 74.12±13.91° to 120.91±17.31°. Schatzker and AO/OTA classifications were associated with KOOS (p<0.001) but not flexion (p=0.160). Definitive internal fixation method was not significantly associated with KOOS outcomes (p=0.817). In robust regression, male sex (β=4.146, p=0.042) and posterior segment count (β=2.011, p=0.022) were positively associated with KOOS improvement, whereas comorbidity (β=−7.245, p=0.012) and provisional external fixation before definitive surgery (β=−8.683, p<0.001) were associated with less improvement, statistically. Conclusion: Recovery following tibial plateau fractures is primarily time-dependent, with fracture severity influencing patient perception but not objective motion. No significant associations were identified between functional outcomes and fixation method or the evaluated fracture-complexity parameters in the present cohort.