Early versus Delayed Definitive Fixation of Tibial Plateau Fractures: A Prospective Study of 40 Cases

Abstract

Background: Tibial plateau fractures are complex injuries often associated with high-energy trauma. The optimal timing for definitive fixation remains debated, particularly regarding functional recovery, complication rates, and fracture reduction quality.

Objective: To compare clinical and radiological outcomes of early (< 72 hours) versus delayed (>72 hours) definitive fixation in patients with tibial plateau fractures.

Methods: Forty patients with isolated tibial plateau fractures were prospectively enrolled and divided into two groups: early fixation (n=23) and delayed fixation (n=17). All patients underwent open reduction and internal fixation (ORIF) using angular-stable locking plates. Functional outcomes were assessed with Lysholm and IKDC scores at 3, 6, and 12 months. Radiological outcomes included articular reduction quality and alignment restoration. Complications, including infection and hardware failure, were recorded.

Results: Early fixation resulted in significantly better articular reduction (p=0.03), faster functional recovery, and slightly lower complication rates compared to delayed fixation. At 12 months, the mean Lysholm score was 88.2 ± 5.1 in the early group versus 81.7 ± 6.4 in the delayed group (p=0.01). IKDC scores showed similar trends. No hardware failures occurred in either group.

Conclusion: Early definitive fixation of tibial plateau fractures provides superior functional and radiological outcomes, with acceptable complication rates. Timing of fixation should be guided by soft tissue status, fracture characteristics, and patient condition.