Tibial plateau fractures are complex injuries with a considerable risk of early revision due to malalignment, infection, or post-traumatic osteoarthritis. This study aimed to identify predictors of early revision surgery and evaluate their clinical utility.

Specific radiological alignment parameters and clinical factors can predict the need for early revision surgery within 12 months.

We retrospectively analyzed 153 patients who underwent surgical fixation for tibial plateau fractures at a Level I trauma center between 2012 and 2022. Radiological assessments included the Rasmussen Score, leg axis deviation, tibial slope, joint line convergence angle (JLCA), and medial proximal tibial angle (MPTA). Logistic regression was performed to identify predictors of revision within 12 months.

Nineteen patients (12.4%) required revision surgery, comprising 10 reosteosynthesis procedures and 9 total knee arthroplasties (TKA). Patients undergoing revision had significantly lower Rasmussen Scores (12 vs. 14, p  = 0.007) and greater fracture impression depth (3 mm vs. 2 mm, p  = 0.004). No significant differences were found for other radiographic parameters. TKA patients were older (59.8 vs. 48.8 years, p  = 0.01) and had higher Charlson Comorbidity Index scores ( p  = 0.013).

Patients requiring early conversion to endoprosthesis were older and had greater comorbidity burdens, supporting the ongoing debate about primary arthroplasty in selected cases. While the Rasmussen Score showed limited predictive value, most radiological parameters were not associated with revision risk. Integration of functional outcomes and advanced imaging may refine surgical decision-making in tibial plateau fracture management.

IV, retrospective observational study.