How long should a patient remain non-weight bearing (NWB) after a proximal tibial fibular fracture?

Non-Weight Bearing Duration After Proximal Tibia-Fibula Fracture

For surgically treated proximal tibial plateau fractures, patients should remain non-weight bearing for 2 weeks, followed by protected weight bearing for an additional 4 weeks, allowing full weight bearing by 6 weeks postoperatively.

Evidence-Based Weight Bearing Protocol

Initial Non-Weight Bearing Phase (0-2 weeks)

• Complete non-weight bearing for the first 2 weeks is recommended to protect the surgical fixation and allow initial healing 1, 2
• During this period, patients should use crutches or a walker with no load on the affected limb 1
• Elevation and ice therapy should be employed to minimize swelling 2

Transition to Protected Weight Bearing (2-6 weeks)

• Begin protected weight bearing at 2 weeks postoperatively with gradual progression 2, 3
• Initial loading should start at toe-touch or less than 10-20kg 4
• Progressive weight bearing advancement is recommended over the subsequent 4 weeks 4
• A protective brace or walking boot may be used during this phase, though evidence for this is variable 4

Full Weight Bearing (6+ weeks)

• Full weight bearing as tolerated should be achieved by 6-10 weeks for most tibial plateau fractures 2, 3, 4
• Earlier weight bearing (before 10 weeks) demonstrates similar union rates and complication profiles compared to traditional 10-12 week protocols 3
• Radiographic union time is not significantly different between early (6.5 weeks) and traditional (11.8 weeks) weight bearing groups 3

Important Clinical Considerations

Fracture Pattern Influences Timing

• More complex fracture patterns (AO/OTA Type C, Schatzker IV-VI) may require longer non-weight bearing periods 4
• Simple fracture patterns with stable fixation can safely progress to earlier weight bearing 5, 3
• The correlation between fracture complexity and weight bearing time is well-established (r=0.465-0.614) 4

Evidence Supporting Early Weight Bearing

• Immediate full weight bearing after plate fixation shows no increased risk of fixation failure or articular collapse in appropriately stabilized fractures 5
• Early weight bearing (starting at 2 weeks) combined with conventional physiotherapy significantly improves pain, knee mobility, quadriceps strength, and quality of life without adverse effects 2
• Patients with early weight bearing protocols recover faster with similar complication rates compared to traditional protocols 3

Special Circumstances

Proximal Tibiofibular Joint Dislocation

• If the injury involves isolated proximal tibiofibular dislocation (without tibial plateau fracture), non-weight bearing for only 2 weeks is sufficient after closed or open reduction 1
• Stable joints after reduction require minimal restriction 1

Monitoring for Complications

• Serial radiographs should be obtained immediately postoperatively, at 6 weeks, and at 3 months to assess for loss of reduction or articular collapse 5, 3
• Subsidence rates are similar between early and traditional weight bearing protocols 3
• Non-union and delayed union occur in approximately 1% of cases regardless of weight bearing protocol 4

Common Pitfalls to Avoid

• Avoid unnecessarily prolonged non-weight bearing beyond 10-12 weeks, as this delays mobility and functional recovery without improving outcomes 3, 4
• Do not apply a one-size-fits-all approach—fracture stability and fixation quality must be assessed intraoperatively to determine appropriate weight bearing progression 5, 4
• Ensure adequate patient education regarding progressive loading to prevent premature full weight bearing that could compromise fixation 2
• Traditional protocols recommending 10-12 weeks before full weight bearing are outdated for most stable fixations 3, 4