Factors influencing patient-reported outcomes in operatively managed tibial plateau fractures

PURPOSE: Tibial plateau fractures are complex injuries with high complication rates, yet their broader impact on patient-reported function and quality of life remains underexplored. This study assessed the impact of demographics, fracture patterns, and treatment characteristics on patient-reported outcomes measurement information system (PROMIS) scores in patients who underwent surgical fixation of tibial plateau fractures. METHODS: A retrospective cohort study was conducted at a Level I trauma center (2022-2024) including adults with operatively treated tibial plateau fractures who completed 6-month PROMIS surveys. Exclusions were age < 18 years, non-operative or percutaneous fixation, and inadequate medical record documentation. Primary outcomes were 6-month scores for PROMIS physical function (PF), pain interference (PI), global physical health (GPH), global mental health (GMH), anxiety/depression, brief resilience scale (BRS), and percent of normal function. Outcomes were compared by sex, age, mechanism of injury, fracture pattern, Schatzker type, and external fixation. RESULTS: Of 413 patients, 106 met inclusion criteria. Mean age was 50.4 years and 51.9% were male. Patients < 50 reported higher PI (62.7 vs. 59.3, p = 0.017) and lower GPH (38.8 vs. 42.4, p = 0.023). Among females, those < 50 had higher PI (64.0 vs. 58.5, p = 0.009), lower GPH (37.5 vs. 43.1, p = 0.011), and lower anxiety (60.2 vs. 64.1, p = 0.046). After adjustment, high-energy injuries were associated with worse GPH (p = 0.014), GMH (p = 0.011), depression (p = 0.009), anxiety (p = 0.015), percent of normal (p = 0.002), and BRS (p = 0.004). CONCLUSION: Early recovery after surgically treated tibial plateau fractures varies by patient and injury characteristics: younger patients, particularly females under 50, reported worse pain and global physical health, while high-energy mechanisms were independently associated with poorer physical and psychological outcomes across multiple domains.