Characteristics of postoperative weight bearing and management protocols for tibial plateau fractures: Findings from a scoping review

Arnold, John B.; Tu, Chen Gang; Phan, Tri M; Rickman, Mark; Varghese, Viju Daniel; Thewlis, Dominic; Solomon, Lucian B.

doi:10.1016/j.injury.2017.10.040

Cited by 31 publications

(40 citation statements)

References 129 publications

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“…Tibial plateau fractures are articular injuries which have a broad spectrum of clinical presentations and are frequently associated with long term complications [1,2]. In recent years these challenging fractures have become a topic of great interest not only regarding their classification but also fixation methods and expected outcomes [3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Revisiting the Schatzker classification of tibial plateau fractures

Kfuri

Schatzker

2018

Injury

184

143

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A B S T R A C TTibial plateau fractures have a broad spectrum of presentations, depending on the mechanism and energy of the trauma. Many classification systems are currently available to describe these injuries. In 1974, Schatzker proposed a classification based on a two-dimensional representation of the fracture. His classification with the six-principles types became one of the most utilized classification systems for tibial plateau fractures. More than four decades after this original publication, we are revisiting each fracture type in the light of information made available by computed tomography, which today comprises a standard tool in assessing articular fractures. The classification we are proposing relies on the fact that the tibial plateau has two anatomical columns, lateral and medial. We are introducing a virtual equator which splits the articular surface in the coronal plane. The equator divides each column into two quadrants, the anterior (A) and the posterior (P). Unicondylar fracture types (I to IV) have now additional modifiers A (anterior) and P (posterior) to describe the exact spatial location of the primary fracture plane. Bicondylar fracture types (V and VI) have the modifiers (A and P) of the main fracture plane for each column, and lateral (L) and medial (M) to denote the column. We are introducing the concept of the main fracture plane. Recognition of the exact location of the principal fracture plane is essential for preoperative planning of patient positioning, surgical approach and for determining where to apply the hardware to achieve stable fixation. The new three-dimensional classification is based on the template of the original Schatzker classification. It covers the mechanism of the injury, the energy of the trauma, the morphologic characteristics of the fracture and its location in three dimensions.

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Section: Introductionmentioning

confidence: 99%

Revisiting the Schatzker classification of tibial plateau fractures

Kfuri

Schatzker

2018

Injury

184

143

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“… 6 , 10 , 18 , 28 – 30 Most frequently, a variety of partial weight-bearing protocols for 4–6 weeks is preferred by the surgeons. 14 Interestingly, Thewlis et al 31 have shown with their gait analysis study that patients who are instructed to partial weight bear, they are self-regulating their weight-bearing status, but nevertheless this fact did not affect the outcomes. Kalmet et al in their retrospective study comparing partial weight bearing with restrictive weight bearing after plate fixation of tibial plateau fractures report no differences in terms of complications and patient reported outcome measure (PROM) outcomes.…”

Section: Discussionmentioning

confidence: 97%

“…The use of the brace could vary from 10 days to 6 weeks. 19 , 20 The use of braces as a post-operative type of immobilisation is not frequently reported in the literature, with only one-third of the studies found by Arnold et al 14 recommending its use.…”

Section: Discussionmentioning

confidence: 99%

Physiotherapy after tibial plateau fracture fixation: A systematic review of the literature

Iliopoulos¹,

Galanis

2020

SAGE Open Medicine

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Background: Tibial plateau fractures are frequent injuries that orthopaedic surgeons face. It has been reported that they have a significant negative impact on the patients’ lives, decreasing their quality of live, keeping them of work for long periods of time and reducing their activity levels. Aim: Interestingly, there is not enough focus in the literature about the post-operative rehabilitation of these patients. The aim of the present review is to investigate this field of the literature and try to give answers in four main questions: the range of motion exercises post-surgery, the immobilisation, the weight-bearing status and the ongoing rehabilitation. Materials and Methods: A literature search was conducted using the PubMed and the Google Scholar search engines. A total of 39 articles met the criteria to be included in the study. Results: The literature about this subject is scarce and controversial. Early range of motion exercises should be encouraged as soon as possible after the procedure. The immobilisation after plate fixation does not seem to be correlated with any benefits to the patients. The weight-bearing status of the patients was the most controversial in the literature with the early weight-bearing gaining ground at the most recent studies. Tibia plateau fractures can have significant impact on the patients’ lives, so ongoing rehabilitation with focus on quadriceps strengthening and proprioception exercises is recommended. Conclusion: The present literature review illuminates the controversy that exists in the literature about the physiotherapy following tibia plateau fracture fixation. Early range of motion exercises and early weight bearing should be encouraged. Immobilisation does not seem to provide any benefit. Ongoing rehabilitation should be considered with the view of better clinical outcomes.

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“…Bracing postoperatively is common practice with rigid braces holding the knee in extension, or more commonly hinged braces used for 3-6 weeks [120]. However, a recent prospective trial conducted by Chauhan et al [121] found no significant difference between 6 weeks of bracing and no bracing at all after ORIF of tibial plateau fractures for union rates, postoperative range of motion, and Medical Outcomes Study 36-Item Short Form scores.…”

Section: Bracingmentioning

confidence: 99%

“…Full weight-bearing is commonly delayed for 9-12 weeks with 4-6 weeks of nonweight bearing followed by 4-6 weeks of partial weight-bearing [120]. Two recent retrospective articles with sample sizes of 17 and 90 have challenged this notion with excellent results with immediate full weight bearing as tolerated [122,123].…”

Section: Weight Bearingmentioning

confidence: 99%

Tibial Plateau Fracture

Schmidt¹,

Szatkowski²,

Riehl³

2020

Tibia Pathology and Fractures

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Tibial plateau fractures are a common orthopedic injury. These fractures involve the articular surface of the tibia that is part of the knee joint. Plateau fractures can range from low energy injuries with little or no displacement to complex fractures with significant associated injuries. Stability of these injuries depends on a combination of bony and associated ligamentous injuries. Treatment consists of a wide spectrum of therapies which have been discussed in this chapter. Complications such as compartment syndrome, post-traumatic arthritis, chronic pain, malunion, and wound problems (in addition to other complications) can develop.

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Characteristics of postoperative weight bearing and management protocols for tibial plateau fractures: Findings from a scoping review

Cited by 31 publications

References 129 publications

Revisiting the Schatzker classification of tibial plateau fractures

Revisiting the Schatzker classification of tibial plateau fractures

Physiotherapy after tibial plateau fracture fixation: A systematic review of the literature

Tibial Plateau Fracture

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