Frailty Predicts Mortality While Fracture Complexity and Reduction Predict Failure After Surgery for Tibial Plateau Fractures in Elderly Patients: A Two-decade Cohort Study
In brief
Frailty predicted mortality, while 57% of ORIF cases developed malunion
In this single-center study of 47 patients aged 65 and older, 21% died over the study period and frailty independently predicted mortality. Among patients treated with open surgery and internal fixation, 57% developed malunion; fracture complexity and non-anatomical reduction predicted reoperation. The small retrospective cohort limits certainty, but highlights reduction quality as a potentially modifiable factor.
- Journal
- The journal of knee surgery (Q1)
- Published
- 29 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Wayne Hoskins, Vivienne Wong, Charles Gusho, Jaime Bellamy, Chloe E H Scott
- PMID
- 42810380
- DOI
- 10.1055/a-2968-6152
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (paper of the day, 1 October 2026): Frailty predicts mortality; fracture complexity predicts failure after tibial plateau
Abstract
Tibial plateau fractures in older patients are increasingly common and carry poor outcomes, yet the determinants of mortality and surgical failure are poorly defined, and frailty, central to hip fracture care, has not been examined in this group. We retrospectively reviewed all patients aged 65 years and older undergoing surgery for a tibial plateau fracture at a single center (2006-2025). Outcomes were all-cause reoperation, malunion, fracture-related infection (FRI), conversion to total knee arthroplasty (TKA), and death (treated as a competing event), analyzed with Fisher's exact test and Firth's penalized logistic regression adjusted for age, fracture complexity, and reduction. Among 47 patients (mean age 73 years; 83% female; open reduction internal fixation [ORIF] in 42, primary TKA in 5), malunion occurred in 57% of ORIF cases, all-cause reoperation in 29%, and FRI in 12%; 15% underwent conversion to TKA at a median of 9 months, accounting for 7 of 13 reoperations. Mortality over the study period was 21% (6% within 1 year). Frailty independently predicted mortality (adjusted odds ratio [aOR] 8.4, 95% confidence interval [CI]: 1.7-61.2) with a clear dose-response, but not reoperation. Fracture complexity (bicondylar/Schatzker 5-6) independently predicted malunion (aOR 7.1, CI: 1.8-37.9), while both complexity (aOR 5.0, CI: 1.2-24.8) and non-anatomical reduction (anatomical reduction protective: aOR 0.20, CI: 0.03-0.91) independently predicted reoperation. The five primary TKA patients, the only group permitted immediate weight-bearing, had fewer reoperations, no infection, no revisions or death, and earlier discharge to home. Mortality and surgical failure had distinct drivers: frailty for death, complexity and malreduction for failure. Reduction quality is the key modifiable surgical variable, and immediate-weight-bearing arthroplasty warrants prospective evaluation in select patients.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.