{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:56:46Z","timestamp":1790726206866,"version":"4.1.0"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u20132025). 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\u201361.2) with a clear dose\u2013response, but not reoperation. Fracture complexity (bicondylar\/Schatzker 5\u20136) independently predicted malunion (aOR 7.1, CI: 1.8\u201337.9), while both complexity (aOR 5.0, CI: 1.2\u201324.8) and non-anatomical reduction (anatomical reduction protective: aOR 0.20, CI: 0.03\u20130.91) 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.<\/jats:p>","DOI":"10.1055\/a-2968-6152","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:58:21Z","timestamp":1790722701000},"source":"Crossref","is-referenced-by-count":0,"title":["Frailty Predicts Mortality While Fracture Complexity and Reduction Predict Failure After Surgery for Tibial Plateau Fractures in Elderly Patients: A Two-decade Cohort Study"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0608-3065","authenticated-orcid":false,"given":"Wayne","family":"Hoskins","sequence":"additional","affiliation":[{"name":"Whang\u0101rei Hospital, Whang\u0101rei, New Zealand","place":["Te Whatu Ora Te Tai Tokerau"],"department":["Northland Orthopaedic Research Consortium"]},{"name":"Northland Knee & Hip, Whang\u0101rei, New Zealand"},{"name":"Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia","place":["Parkville"],"department":["Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivienne","family":"Wong","sequence":"additional","affiliation":[{"name":"Whang\u0101rei Hospital, Whang\u0101rei, New Zealand","place":["Te Whatu Ora Te Tai Tokerau"],"department":["Northland Orthopaedic Research Consortium"]},{"name":"University of Auckland - City Campus, Auckland, New Zealand","place":["Auckland"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Gusho","sequence":"additional","affiliation":[{"name":"University of Missouri, Missouri, United States","place":["Columbia"],"department":["Department of Orthopaedics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Bellamy","sequence":"additional","affiliation":[{"name":"University of Missouri - Kansas City, Missouri, United States","place":["Kansas City"],"department":["Department of Orthopedics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe E. H.","family":"Scott","sequence":"additional","affiliation":[{"name":"Royal Infirmary of Edinburgh, United Kingdom","place":["Edinburgh"],"department":["Department of Orthoapedics"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1177\/2151458516651310","article-title":"Tibial plateau fractures in elderly patients","volume":"7","author":"J C Rozell","year":"2016","journal-title":"Geriatr Orthop Surg Rehabil"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1080\/17453674.2019.1698148","article-title":"20-year trends of distal femoral, patellar, and proximal tibial fractures: a Danish nationwide cohort study of 60,823 patients","volume":"91","author":"V Vestergaard","year":"2020","journal-title":"Acta Orthop"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"112938","DOI":"10.1016\/j.injury.2025.112938","article-title":"Approaching the posterolateral quadrant of the tibial plateau: challenges and strategies","volume":"57","author":"W Hoskins","year":"2026","journal-title":"Injury"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"143563","DOI":"10.52965\/001c.143563","article-title":"The role of immediate arthroplasty in elderly tibial plateau fractures","volume":"17","author":"B Naylor","year":"2025","journal-title":"Orthop Rev (Pavia)"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/CORR.0000000000003727","article-title":"What is the association between radiographic measurements of initial and residual fracture displacement, tibial alignment, and recovery in terms of patient-reported outcome after surgical treatment of tibial plateau fractures?","volume":"484","author":"T P Vaartjes","year":"2026","journal-title":"Clin Orthop Relat Res"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1097\/CORR.0000000000003854","article-title":"Acute or delayed TKA for tibial plateau fracture? An observational study from the Swedish Arthroplasty Register","volume":"484","author":"F Olerud","year":"2026","journal-title":"Clin Orthop Relat Res"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"101209","DOI":"10.1016\/j.artd.2023.101209","article-title":"Acute total knee arthroplasty for unicondylar tibial plateau fracture using metaphyseal cones","volume":"23","author":"C EH Scott","year":"2023","journal-title":"Arthroplast Today"},{"issue":"10","key":"ref8","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1302\/2046-3758.1410.BJR-2024-0579.R1","article-title":"Biomechanical evaluation of asymmetric metaphyseal cone applications for lateral tibial plateau fractures: a finite element study","volume":"14","author":"Y Ren","year":"2025","journal-title":"Bone Joint Res"},{"issue":"12","key":"ref9","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1302\/2633-1462.612.BJO-2025-0278.R1","article-title":"The requirement for total knee arthroplasty following surgical fixation of tibial plateau fractures","volume":"6","author":"M Strafford","year":"2025","journal-title":"Bone Jt Open"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people","volume":"173","author":"K Rockwood","year":"2005","journal-title":"CMAJ"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"210","DOI":"10.5770\/cgj.23.463","article-title":"Using the Clinical Frailty Scale in allocating scarce health care resources","volume":"23","author":"K Rockwood","year":"2020","journal-title":"Can Geriatr J"},{"issue":"138","key":"ref12","first-page":"94","article-title":"The tibial plateau fracture. The Toronto experience 1968\u20131975","author":"J Schatzker","year":"1979","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias reduction of maximum likelihood estimates","volume":"80","author":"D Firth","year":"1993","journal-title":"Biometrika"},{"issue":"03","key":"ref14","first-page":"141","article-title":"An empirical transition matrix for non-homogeneous Markov chains based on censored observations","volume":"5","author":"O O Aalen","year":"1978","journal-title":"Scand J Stat Theory Appl"},{"issue":"12","key":"ref15","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"P Peduzzi","year":"1996","journal-title":"J Clin Epidemiol"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"144","DOI":"10.2106\/JBJS.L.01691","article-title":"Risk of total knee arthroplasty after operatively treated tibial plateau fracture: a matched-population-based cohort study","volume":"96","author":"D Wasserstein","year":"2014","journal-title":"J Bone Joint Surg Am"},{"issue":"26","key":"ref18","first-page":"00563-2","article-title":"The AAHKS Surgical Techniques and Technologies Award: what is the ideal technique and implant in aseptic revision total knee arthroplasty? An analysis of second revision and component loosening rates from the Australian Orthopaedic Association National Joint Replacement Registry","volume":"S0883-5403","author":"W Hoskins","year":"2026","journal-title":"J Arthroplasty"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1302\/0301-620X.106B1.BJJ-2023-0172.R2","article-title":"Pre-existing knee osteoarthritis and severe joint depression are associated with the need for total knee arthroplasty after tibial plateau fracture in patients aged over 60 years","volume":"106-B","author":"S Gupta","year":"2024","journal-title":"Bone Joint J"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1302\/2633-1462.44.BJO-2023-0022.R1","article-title":"Tibial plateau fractures in older adults are associated with a clinically significant deterioration in health-related quality of life","volume":"4","author":"S Gupta","year":"2023","journal-title":"Bone Jt Open"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2968-6152.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:58:24Z","timestamp":1790722704000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2968-6152"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":19,"URL":"https:\/\/doi.org\/10.1055\/a-2968-6152","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]}}}