Tibial tubercle involvement in tibial plateau fractures is associated with nonunion, reoperation, and flexion deficits.

Abstract

Tibial tubercle involvement (TTI) in tibial plateau fractures (TPF) is understudied. We evaluated whether TTI is associated with major postoperative complications and range-of-motion (ROM) recovery after operative TPF compared with isolated TPF (iTPF). We performed a retrospective cohort study of operatively treated TPFs from 2014 to 2025. TTI was identified using radiographs, CT scans, and operative reports. Primary outcomes were knee ROM (flexion and extension) at 6 weeks, 12 weeks, and 1 year, as well as postoperative complications including reoperation and nonunion. Covariates included demographics, injury and operative characteristics, complications, and postoperative weight-bearing/immobilization status. Among 132 TPFs, 38 (28.6%) had TTI and 94 (71.2%) were iTPF, with similar baseline age, BMI, sex, and ISS. TTI injuries were more frequently Schatzker VI and open, whereas iTPF were more commonly Schatzker II. Weight-bearing prescriptions were similar, but immobilization was more frequent with TTI. Compared with iTPF, TTI was not associated with significantly different flexion at 6 weeks, but was associated with lower flexion at 12 weeks (adjusted difference - 27.31°, 95% CI [- 37.73, - 16.88]; p < 0.001) and at 1 year (adjusted difference - 19.94°, 95% CI [- 35.41, - 4.48]; p = 0.011). Extension recovery did not differ over time. In the cohort with ≥ 3-month follow-up, TTI was associated with higher reoperation (39.4% vs. 11.2%, p = 0.001), nonunion (15.2% vs. 2.5%, p = 0.022), and culture-positive infection requiring reoperation (30.3% vs. 10.0%, p = 0.011). In adjusted analysis, TTI remained associated with any reoperation (OR 3.95, 95% CI [1.36, 11.48]; p = 0.012). TTI was associated with higher rates of nonunion and reoperation after operative treatment of TPF, and with reduced flexion ROM at both 12 weeks and 1 year. However, these findings should be interpreted in the context of greater injury severity and more frequent postoperative immobilization in the TTI cohort.