From Early Complications to Delayed Failures: Revision Surgery After Tibial Plateau Fracture Fixation in 1027 Cases

Tibial plateau fractures (TPFs) are complex injuries associated with significant postoperative complications including infection, deformity and wound healing disorders. Limited data exist on risk factors for complications following surgical treatment, particularly in large multicenter cohorts. This retrospective study analyzed 1027 patients with intra-articular TPFs treated surgically at two level-I trauma centers in Germany (2011-2020). Preoperative CT imaging and follow-up data were required for inclusion. Complications were categorized into seven groups (infection, deformity, wound healing disorders, postoperative compartment syndrome, range of motion deficit and others). Statistical analyses assessed associations with fracture type (Schatzker classification), surgical approach, duration, and patient factors (BMI, age, smoking). Nineteen percent of patients required surgical revision, with deformity (5.7 %), infection (5.4 %), and wound healing disorders (3.3 %) being the most common complications. Complex fractures (Schatzker V-VI) and prolonged or multi-approach surgeries were associated with higher complication rates. Elevated BMI increased overall complication risk, while smoking was linked to wound healing disorders. The 19 % revision rate highlights the challenges of managing TPFs. Surgical factors, including operative duration and approach, play a critical role in the occurrence of complications, emphasizing the need for tailored strategies based on fracture complexity and surgical considerations.