Proximal tibial fractures are complex injuries with an annual incidence of 10–13 per 10.000 individuals, posing significant medical and socioeconomic challenges [[1], [2], [3], [4], [5]]. These fractures commonly result from high-energy trauma such as vehicle accidents or falls from height and predominantly affect the working-age population [[6], [7], [8], [9]]. Treatment of complex proximal tibial fractures (AO/OTA type B and C) typically involve surgical treatment, ranging from internal plate fixation to the use of external fixators. Key therapeutic goals are anatomical restoration, preservation of joint function, and prevention of long-term complications such as joint instability, arthrofibrosis, or post-traumatic osteoarthritis as they are key factors for impaired functional outcome and patient satisfaction [[10], [11], [12], [13], [14]].

The return to work after proximal tibial fractures, particularly in cases of occupational injuries, is often complicated by the physical demands of employment and workplace obligations. Physical workload, measured by systems like the REFA classification (details see below), is a critical factor influencing recovery and rehabilitation. Studies indicate that higher physical workload correlates with longer periods of absence and reduced likelihood of returning to the original job [15]. Patients receiving workers’ compensation frequently report lower satisfaction and worse functional outcomes, likely influenced by psychosocial factors and heightened expectations. Return to work serves as a marker not only of physical recovery but also of psychosocial and economic reintegration [16]. However, patients whose jobs require high levels of physical workload often face challenges, including chronic pain, reduced functionality and the need for workplace adaptations. At the same time, studies show that targeted return-to-work interventions and realistic expectation management strategies can promote return to work [17].

The economic burden of proximal tibial fractures is substantial. Direct costs include surgical intervention and rehabilitation, while indirect costs stem from prolonged work absences, reduced employability, and the need for long-term care [18]. These injuries significantly disrupt quality of life and economic productivity, especially in the working-age population, emphasizing the need for effective, patient-centered management strategies [[19], [20], [21]]. While restoration of mobility and function is crucial, full return to previous levels of work is often unachievable- even with optimal care. Patients frequently overestimate their recovery potential, particularly in terms of work and lifestyle, underscoring the need for structured patient management to enhance satisfaction and functional results [13,22]. Patient satisfaction extends beyond clinical outcomes and depends on factors such as effective pain management, realistic preoperative expectations, trust in the medical team, and psychosocial well-being [17,[23], [24], [25]]. For this, patient-reported outcomes and expectation assessments offer key insights into physical and psychological recovery, helping to improve care and support return to daily activities and work [13,[19], [20], [21],[26], [27], [28], [29]].

The hypothesis of the study was that patients with high physical workload (I) and/or workers’ compensation status (II) do not meet fulfillment of preoperative expectations after surgical treatment of complex proximal tibial fractures (AO/OTA type B or C), and that return to initial work was less often possible in physically high demanding jobs (III).