Short-, Mid-, and Long-Term Outcomes Following Open Displaced Bicondylar Tibial Plateau Fractures in a Large Retrospective Cohort

Objectives To characterize short-, mid-, and long-term complications, reoperation, and osteoarthritis after operative treatment of open displaced bicondylar tibial plateau fractures. Methods Design Retrospective case series. Setting Multicenter electronic health record database of academic and community healthcare organizations. Patient Selection Criteria Adults 18 years and older undergoing open reduction and internal fixation (CPT 27536) for an open displaced bicondylar tibial plateau fracture between April 2006 and April 2021 were included. AO/OTA subclassification was not available in the database; the qualifying diagnosis codes represented displaced bicondylar tibial plateau fractures and specified open-fracture Gustilo-Anderson categories. Prior total knee arthroplasty, prior knee osteoarthritis, and no encounter after the index procedure were exclusions. No minimum follow-up was required. Outcome Measures and Comparisons Infection, venous thromboembolism (VTE), revision surgery, hardware removal, compartment syndrome, neurovascular injury, and osteoarthritis were ascertained from ICD-10 and CPT codes within prespecified post-index analytic windows. Crude outcome proportions were calculated at 1, 3, and 6 months and 1, 3, and 5 years; Kaplan-Meier methods were used to estimate event-free survival with censoring at the last encounter. No comparison cohort was analyzed. Results Of 484 patients, mean age was 46.1 ± 15.1 years (range, 18-80) and 73.8% were male. Median follow-up was 1,551 days (IQR, 1,398; range, 90-1,825). Infection reached 5.4% at 1 month and 13.8% at 5 years, with 58 of 67 infections (86.6%) occurring within 1 year. Osteoarthritis rose from 4.8% at 6 months to 19.0% at 5 years, and hardware removal reached 22.9%. VTE reached 11.6%, revision surgery 4.8%, compartment syndrome 3.7%, and neurovascular injury 6.4% at 5 years. Conclusions Open displaced bicondylar tibial plateau fractures carried substantial early and long-term morbidity. Infection accumulated mainly within the first postoperative year, whereas osteoarthritis continued rising through 5 years, supporting early complication prevention and sustained surveillance for joint degeneration. Level of Evidence Level IV, retrospective case series.