Non-Weight Bearing Duration for Tibial Plateau Fractures
Patients with operatively treated tibial plateau fractures can safely begin full weight bearing as tolerated immediately after surgery, or at minimum should not remain non-weight bearing beyond 6-8 weeks.
Evidence-Based Weight Bearing Protocol
Immediate Weight Bearing (Preferred Approach)
- Full weight bearing as tolerated can be initiated immediately postoperatively without increased risk of fixation failure, articular collapse, or loss of reduction 1
- A study of 90 patients demonstrated no failure of fixation in patients allowed immediate full weight bearing, with only one patient (3.3%) showing minimal joint depression (4mm) that did not progress 1
- Immediate weight bearing provides physiological benefits for fracture healing and avoids complications associated with prolonged non-weight bearing 1
Early Weight Bearing Protocol (Alternative)
- Patients can safely begin weight bearing before 10 weeks with outcomes equivalent to traditional protocols 2
- Early weight bearing (average 6.5 weeks) showed no difference in radiographic time to union (93.5 days vs 103.7 days), complication rates, or subsidence compared to traditional protocols starting at 10+ weeks 2
- Historical data from 86 lateral tibial plateau fractures demonstrated that early weight bearing in a cast brace did not produce further depression greater than 2mm 3
Traditional Protocol (Outdated but Still Common)
- The classic approach of 10-12 weeks non-weight bearing or partial weight bearing lacks supporting evidence and unnecessarily delays recovery 2, 1
- When this conservative approach is used, patients typically remain non-weight bearing for 6-8 weeks, followed by progressive weight bearing until 12 weeks or complete fracture union 4
Biomechanical Evidence
- Peak loading during walking does not exceed the elastic limit of the fracture construct and is not associated with fracture migration 5
- Fractures progressively loaded during rehabilitation showed migration within clinically acceptable limits over the first postoperative year 5
- The point of load application shifts from neutral to medial by week 26, suggesting adaptive remodeling without construct failure 5
Fracture-Specific Considerations
- Fracture classification (Schatzker type) does not appear to mandate different weight bearing protocols when adequate surgical fixation is achieved 2
- Both simple (B3) and complex (C3) fracture patterns showed similar outcomes with early weight bearing 2
- Type III fractures treated operatively had 83% satisfactory results with early weight bearing versus 53% when treated non-operatively 3
Critical Implementation Points
- Early range of motion should begin soon after surgery regardless of weight bearing status 4, 3
- Patients with insecurely fixed fractures may require 3-6 weeks of cast immobilization before initiating weight bearing 4
- The key determinant is surgical fixation quality, not arbitrary time-based restrictions 1
Common Pitfalls to Avoid
- Avoid reflexively prescribing 10-12 weeks of non-weight bearing based on outdated protocols when modern fixation techniques allow earlier mobilization 2, 1
- Do not delay weight bearing in well-fixed fractures out of theoretical concerns about hardware failure—the evidence shows this fear is unfounded 1, 5
- Ensure patients understand "weight bearing as tolerated" means progressive loading based on pain, not unlimited immediate full loading 1, 5