From the Research
The recommended treatment for a non-displaced tibial plateau fracture typically involves non-surgical management with protected weight-bearing and rehabilitation. Initially, patients should use crutches or a walker and avoid putting weight on the affected leg for 6-8 weeks, following a progressive weight-bearing protocol as directed by their orthopedic surgeon 1. A hinged knee brace is often prescribed to stabilize the knee while allowing controlled motion, typically worn for 4-6 weeks. Pain management includes acetaminophen (500-1000mg every 6 hours as needed) and NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) for the first 1-2 weeks, with stronger prescription medications used sparingly if necessary.
Key Considerations
- Physical therapy should begin early with gentle range-of-motion exercises, progressing to strengthening exercises as healing advances, typically starting 1-2 weeks after injury.
- Regular follow-up with orthopedic specialists is essential, with X-rays at 2,6, and 12 weeks to monitor healing.
- This conservative approach works well because non-displaced fractures maintain the structural integrity of the bone, allowing natural healing processes to occur while protecting the fracture site from displacement that could lead to joint incongruity and future arthritis.
Evidence-Based Recommendations
The most recent and highest quality study, the S2k Guideline for Tibial Plateau Fractures, published in 2024, emphasizes the importance of a standardized and structured approach to the treatment of tibial plateau fractures, including non-displaced fractures 1. While other studies, such as those published in 2014 2, 2016 3, 1981 4, and 1979 5, provide valuable insights into the treatment of tibial plateau fractures, the 2024 guideline provides the most up-to-date and comprehensive recommendations for the management of non-displaced tibial plateau fractures.
Treatment Protocol
- Patients with non-displaced tibial plateau fractures should be managed conservatively with protected weight-bearing and rehabilitation.
- A hinged knee brace should be used to stabilize the knee and allow controlled motion.
- Pain management should include acetaminophen and NSAIDs, with stronger prescription medications used sparingly if necessary.
- Physical therapy should begin early and progress from gentle range-of-motion exercises to strengthening exercises as healing advances.