When can a hinged knee brace be discontinued and weight-bearing as tolerated be initiated after a tibial plateau fracture with compression?

When to Discontinue Hinged Knee Brace and Weight Bear as Tolerated After Tibial Plateau Fracture

Weight bearing as tolerated can be initiated immediately after surgical stabilization of tibial plateau fractures, and hinged knee braces can be discontinued when adequate healing and stability are achieved, typically around 6-12 weeks post-surgery. 1

Weight Bearing Protocol

• Immediate full weight bearing as tolerated is safe following surgical fixation of tibial plateau fractures and does not lead to loss of fixation or articular collapse 1
• Studies show no negative effects on patient-reported outcomes at 52 weeks with early weight bearing, despite poor adherence to traditional weight bearing restrictions 2
• Early weight bearing has not been shown to produce further depression greater than 2mm in tibial plateau fractures 3
• For patients with tibial plateau fractures treated with compression plates and screws, immediate post-operative weight bearing does not affect fixation stability up to three months after surgery 1

Hinged Knee Brace Discontinuation

• Hinged knee braces can typically be discontinued when:

  • Adequate fracture healing is demonstrated on radiographs (usually 6-12 weeks) 4
  • Patient demonstrates good quadriceps control and knee stability 5
  • Range of motion has improved sufficiently 4
  • Pain has decreased to manageable levels 5

• Guidelines recommend against postoperative functional bracing for extended periods as they provide no additional benefit and may impede rehabilitation progress 6

Rehabilitation Progression

• Early knee mobilization should be implemented following surgical fixation to:

  • Increase joint range of motion 5
  • Reduce knee pain 5
  • Prevent extension deficits and other soft tissue complications 5

• Closed kinetic chain exercises should be prioritized in the early rehabilitation phase (first 4 weeks) 5

• Open kinetic chain exercises (90°-45° range) can be introduced as early as 4 weeks post-surgery 5

Factors Affecting Brace Discontinuation Timeline

• Fracture pattern and severity influence the timeline for brace discontinuation 5
• Surgical fixation method and stability affect when the brace can be removed 1
• Patient-specific factors to consider:
  • Age and bone quality 5
  • Compliance with rehabilitation protocols 2
  • Presence of associated ligamentous injuries 5
  • Overall functional status and muscle control 5

Clinical Assessment Before Discontinuing Brace

• Radiographic evidence of fracture healing with no signs of fixation failure 1
• Physical examination demonstrating:
  • Stable knee joint without excessive varus/valgus laxity 5
  • Adequate quadriceps strength (at least 60% of contralateral side) 5
  • Functional range of motion (at least 0-90 degrees) 5
  • Minimal pain with weight bearing activities 5

Common Pitfalls to Avoid

• Prolonged use of knee braces can lead to muscle atrophy and joint stiffness 6
• Delaying weight bearing unnecessarily may impede recovery and lead to complications of immobility 1
• Relying solely on time-based criteria rather than functional and clinical assessment for brace discontinuation 6
• Failing to provide adequate patient education about proper brace use and weaning protocol 5

Special Considerations

• For patients with concomitant ligamentous injuries, brace discontinuation may need to be delayed 5
• Patients with poor bone quality or osteoporosis may require longer bracing periods 5
• For complex or high-energy fracture patterns, a more cautious approach to weight bearing progression may be warranted, though full weight bearing has still been shown to be safe 1, 7