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Purpose <p>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).</p> Methods <p>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.</p> Results <p>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 [−&#xa0;37.73, −&#xa0;16.88]; <i>p</i> &lt; 0.001) and at 1 year (adjusted difference − 19.94°, 95% CI [−&#xa0;35.41, −&#xa0;4.48]; <i>p</i> = 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%, <i>p</i> = 0.001), nonunion (15.2% vs. 2.5%, <i>p</i> = 0.022), and culture-positive infection requiring reoperation (30.3% vs. 10.0%, <i>p</i> = 0.011). In adjusted analysis, TTI remained associated with any reoperation (OR 3.95, 95% CI [1.36, 11.48]; <i>p</i> = 0.012).</p> Conclusion <p>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.</p>

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

  • 期刊论文

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  • 发表日期：

    2026年7月29日

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  • Robert G. Hernandez,
  • David Dallas-Orr,
  • Noah L. Lyndall,
  • Tyler E. Lockwood,
  • Shannon Tse,
  • Gillian L. S. Soles,
  • Ellen P. Fitzpatrick,
  • Mark A. Lee,
  • Sean T. Campbell,
  • Augustine M. Saiz

摘要

Purpose

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).

Methods

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.

Results

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).

Conclusion

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.