Introduction: The treatment algorithm for tibial plateau fractures continues to evolve as surgeon experience increases. Initial surgical procedures have been fine-tuned over time. Methods: This is a retrospective chart review of 132 patients with low-energy tibial plateau fractures (Schatzker I–IV) treated at a level-1 academic trauma center between January 2008 and February 2018. This study analyzes patient outcomes managed with primary operative intervention within 48 hours of admission. The average age was 45 years (range, 19 to 84 years). There were 92 men and 40 women. Statistical analysis focused on comparisons between historical complication rates and the findings of this study. The study was powered for short-term outcomes (1- to 3-month follow-up), with a few select patients followed-up with for 12 to 15 months. Study variables consisted of length of hospital stay, age, and time to follow-up. Results: The average length of stay was 4.68 days with an overall complication rate of 10.6%. Complications included infections (6.06%), compartment syndrome (1.52%), persistent pain and stiffness (1.52%), and other causes (1.52%). There were no statistically significant differences when compared to complication rates cited in the literature (P > 0.05). Conclusion: Although the optimal timing of treatment for tibial plateau fractures remains debatable, it is clear that early surgical intervention provides the advantage of immediate repair. Our data shows that Schatzker fractures (I–IV) may be safely operated on within 48 hours without a significant increase in complications. Early surgical intervention provides several advantages, including easier anatomical reduction, speedier recovery, reduced hospital length of stay, and reduced cost.

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