Objective <p>Deep vein thrombosis (DVT) is a serious complication in patients with tibial plateau fractures, yet the association between surgical delay and preoperative DVT risk remains insufficiently explored. This study aimed to investigate the impact of fracture-to-operation time on preoperative DVT risk in this patient population.</p> Methods <p>A retrospective association analysis was conducted on 267 patients with tibial plateau fractures treated at Quanzhou Orthopedic Hospital between January 2020 and January 2022. The primary exposure was fracture-to-operation time, and the outcome was preoperative DVT confirmed by ultrasound. Multiple regression analyses and generalized additive models were employed, adjusting for demographic, clinical, and coagulation parameters.</p> Results <p>The incidence of thrombosis before the operation for tibial plateau fractures is as high as 27.34%. Each day of surgical delay was associated with a 48% increased risk of DVT (adjusted OR = 1.48, 95% CI: 1.32–1.67). A non-linear trend was observed, with risk increasing more rapidly within the first 14 days post-fracture. Patients in the highest tertile of surgical delay had a significantly elevated DVT risk compared to the lowest tertile (adjusted OR = 35.27, 95% CI: 9.53–130.56). Subgroup analyses confirmed the robustness of this association across age groups, calcaneus traction status, and D-dimer levels.</p> Conclusion <p>Delayed surgery is associated with increased preoperative DVT risk in tibial plateau fracture patients, and this association appears stronger within the first 14 days post-injury. Early surgical intervention may mitigate this risk, supporting the need for timely management in clinical practice. However, these findings require validation in prospective studies.</p>