From the Guidelines
One month after a tibial plateau fracture, physical therapy should focus on gentle, progressive exercises to improve range of motion and begin light strengthening without compromising fracture healing, with a emphasis on pain management and gradual progression of weight-bearing activities, as recommended by the most recent study 1.
Key Considerations
- Non-weight bearing or partial weight bearing exercises are recommended, following the orthopedic surgeon's specific weight-bearing restrictions, to prevent excessive stress on the healing bone 2.
- Appropriate exercises include: + Ankle pumps + Gentle knee flexion and extension while seated + Quadriceps sets + Straight leg raises + Gentle hamstring stretches
- Pool therapy may be beneficial as the buoyancy reduces stress on the healing bone, allowing for earlier mobilization and strengthening 3.
Progression of Exercises
- Physical therapy sessions 2-3 times weekly are typically recommended, supplemented by a home exercise program, to ensure consistent progression and monitoring of the patient's condition 2.
- Pain should guide activity level—mild discomfort is acceptable, but sharp pain indicates a need to reduce intensity, as excessive pain can compromise fracture healing and lead to further complications 4.
- Proper pain management with prescribed medications or over-the-counter options like acetaminophen can help facilitate exercise participation, improving patient adherence and outcomes 2.
Long-term Goals
- As healing progresses, the physical therapist will gradually advance the program to include more weight-bearing and functional exercises based on the patient's specific healing timeline and surgeon's recommendations, aiming to restore full range of motion, strength, and functional ability 1.
- The ultimate goal is to prevent joint stiffness, muscle atrophy, and maintain circulation while the fracture heals, ensuring optimal recovery and minimizing the risk of long-term morbidity and mortality 3.
From the Research
Exercises and Physical Therapy
One month post tibial plateau fracture, the following exercises and physical therapy are recommended:
- Early range of motion exercises should be encouraged as soon as possible after the procedure 5
- Ongoing rehabilitation with focus on quadriceps strengthening and proprioception exercises is recommended 5
- Weight-bearing status of the patients was the most controversial in the literature, with early weight-bearing gaining ground in the most recent studies 5, 6
- Partial weight bearing protocols and brace use were varied, with the most commonly reported non-weight bearing time after surgery being 4-6 weeks 6
- Time to full weight bearing was positively correlated with the proportion of fractures of AO/OTA type C and Schatzker type IV-VI 6
Rehabilitation Protocols
Rehabilitation protocols for tibial plateau fractures may include:
- Significant non-weight bearing time before full weight bearing is recommended at 9-12 weeks 6
- Use of rigid or hinged braces, most frequently for 3-6 weeks 6
- Loading recommendations for initial weight bearing, with most commonly toe-touch/<10kg, 10kg-20kg, and progressive 6
- Immobilisation after plate fixation does not seem to be correlated with any benefits to the patients 5
Management Strategies
Management strategies for tibial plateau fractures are largely dependent on the management of each particular configuration, with limited consensus in the literature 7