Effect of complications and reoperations on PROMIS scores for tibial plateau fractures.

PURPOSE: Tibial plateau fractures can result in significant morbidity, and complications following surgical fixation may negatively impact recovery. We aimed to evaluate whether such complications influence patient-reported outcomes at 6 months postoperatively.

METHODS

We conducted a retrospective cohort study at a single level I trauma center from 2022 to 2024. Adult patients who sustained a tibial plateau fracture (AO/OTA 41) treated with open reduction internal fixation (ORIF) were eligible for inclusion if they had completed Patient-Reported Outcomes Measurement Information System (PROMIS) surveys at 6 months postoperatively and had clinical follow-up confirming radiographic healing. Patients were excluded if they were under 18 years of age, lacked adequate medical record documentation, were managed non-operatively or with closed reduction percutaneous fixation, or did not complete PROMIS surveys at the 6-month time point. The primary outcomes were PROMIS scores assessing physical function (PF), pain interference (PI), global physical health (GPH), global mental health (GMH), anxiety, and depression. Secondary outcomes included percent of normal function and Brief Resilience Scale (BRS) scores. These outcomes were compared between patients who experienced complications and those who did not.

RESULTS

A total of 106 patients were included (mean age 50.4 years; mean follow-up 261.5 days). Complications occurred in 25.5% of patients, including fracture-related infection (FRI, 10.4%), DVT/PE (7.5%), and reoperation within 6 months (11.3%). Patients with FRI had significantly lower PROMIS-PF scores at 6 months compared to those without FRI (31.5 vs. 37.4, p = 0.015), exceeding the MCID. Other PROMIS domains were not significantly different. Patients undergoing early reoperation prior to 6 months, or reoperation to promote bone healing at any timepoint, demonstrated lower PF scores, though these differences were not statistically significant.

CONCLUSION

In this cohort of patients with tibial plateau fractures, FRI was associated with significantly worse physical function at 6-months as measured by the PROMIS-PF score. This difference was also clinically significant, exceeding the MCID.