Characteristics of postoperative weight bearing and management protocols for tibial plateau fractures: Findings from a scoping review |
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| Affiliation: | 1. Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia;2. Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Port Road, Adelaide, SA, Australia;3. Hospital for Trauma and Orthopaedics, Ho Chi Minh, Vietnam;4. Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, Australia;1. Department of Oral and Maxillofacial Surgery/Pathology & 3D Innovation Lab, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands;2. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hasanuddin, Makassar, Indonesia;3. Department of Oral and Maxillofacial Surgery, University of Oulu, Oulu University Hospital, Oulu, Finland;1. Academic Department of Trauma and Orthopaedics, Floor D, Clarendon Wing, LGI, University of Leeds, Leeds, UK;2. NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK;1. University hospital of Erlangen, Department of Orthopedic and Trauma Surgery, Krankenhausstr. 12, 91054 Erlangen, Germany;2. University hospital of Erlangen, Department of Pediatric Surgery, Krankenhausstr. 12, 91054 Erlangen, Germany;3. University of Erlangen, Institute of Anatomy I, Krankenhausstr. 12, 91054 Erlangen, Germany;1. Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands;2. Department of Orthopaedic Surgery, Leiden University Medical Center, The Netherlands;1. Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands;2. Department of Thrombosis and Haemostasis, Leiden University Medical Center, The Netherlands |
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| Abstract: | ![]()
ObjectiveTo identify and describe the characteristics of existing practices for postoperative weight bearing and management of tibial plateau fractures (TPFs), identify gaps in the literature, and inform the design of future research.MethodsSeven electronic databases and clinical trial registers were searched from inception until November 17th 2016. Studies were included if they reported on the surgical management of TPFs, had a mean follow-up time of ≥1 year and provided data on postoperative management protocols. Data were extracted and synthesized according to study demographics, patient characteristics and postoperative management (weight bearing regimes, immobilisation devices, exercises and complications).Results124 studies were included involving 5156 patients with TPFs. The mean age across studies was 45.1 years (range 20.8–72; 60% male), with a mean follow-up of 34.9 months (range 12–264). The most frequent fracture types were AO/OTA classification 41-B3 (29.5%) and C3 (25%). The most commonly reported non-weight bearing time after surgery was 4–6 weeks (39% of studies), with a further 4–6 weeks of partial weight bearing (51% of studies), resulting in 9–12 weeks before full weight bearing status was recommended (55% of studies). Loading recommendations for initial weight bearing were most commonly toe-touch/<10 kg (28%), 10 kg–20 kg (33%) and progressive (39%). Time to full weight bearing was positively correlated with the proportion of fractures of AO/OTA type C (r = 0.465, p = 0.029) and Schatzker type IV–VI (r = 0.614, p < 0.001). Similar rates of rigid (47%) and hinged braces were reported (58%), most frequently for 3–6 weeks (43% of studies). Complication rates averaged 2% of patients (range 0–26%) for abnormal varus/valgus and 1% (range 0–22%) for non-union or delayed union.ConclusionsPostoperative rehabilitation for TPFs most commonly involves significant non-weight bearing time before full weight bearing is recommended at 9–12 weeks. Partial weight bearing protocols and brace use were varied. Type of rehabilitation may be an important factor influencing recovery, with future high quality prospective studies required to determine the impact of different protocols on clinical and radiological outcomes. |
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| Keywords: | Proximal tibia Weight bearing Tibial plateau fracture Rehabilitation Management Postoperative |
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