Immediate weight-bearing after tibial plateau fractures internal fixation results in better clinical outcomes with similar radiological outcomes: a randomized clinical trial.

Abstract

Purpose: To investigate the effects of adding immediate weight-bearing to tolerance into a post-operative rehabilitation program for surgically treated Tibial Plateau (TP) fractures on clinical and radiological outcomes.

Methods: A randomized control trial. 106 Patients were recruited following open reduction internal fixation (ORIF) TP fracture, with 54 patients meeting the criteria for inclusion. Patients were assigned randomly into one of two groups: (1) the traditional group (TG) and (2) the weight-bearing group (WG). The TG was given the non-weight-bearing (NWB) rehabilitation protocol for six weeks. The WG was allowed immediate weight-bearing, and the same therapeutic exercise program was given to both groups. The dependent variables, including clinical and radiological measurements, were recorded six weeks, three months, and six months after the surgery.

Results: A total of 45 patients (11 women and 34 men), with a mean age of 43 ± 14 years, completed the study. There were significant differences between groups in favor of the WG at 6-months for the total clinical Rasmussen score (p =.002) as well as for the pain (p =.005), walking capacity (p =.002), and knee ROM (p =.047). We found neither difference between groups regarding radiological CT- Scan and X-ray measures nor Rasmussen's radiological scores (p =.854). Fracture type (Schatzker I-IV) did not affect any radiological measures between the groups. Four of 45 patients had intra-articular collapse, three in TG and one in WG (p =.571).

Conclusion: Immediate weight-bearing as tolerated after ORIF of TP fractures (Schatzker I-IV) resulted in better clinical outcomes with no significant differences in the radiological measures.