Immediate weight bearing after plate fixation of fractures of the tibial plateau

Williamson, Michael; Iliopoulos, Efthymios; Jain, Abhishek; Ebied, W; Trompeter, Alex

doi:10.1016/j.injury.2018.06.039

Cited by 31 publications

(15 citation statements)

References 23 publications

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“…Williamson et al displayed in a study of 90 patients, divided into 60 patients performing partial weight and 30 patients performing full weight-bearing after internal fixation of a proximal tibia fracture with a plate, that early full weight-bearing was not as-sociated with a higher number of complications [14]. This study is limited by the design of a retrospective, only radiographic investigation.…”

Section: Discussionmentioning

confidence: 92%

Influence of Weight Bearing on Postoperative Complications after Surgical Treatment of the Lower Extremity

et al. 2022

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Purpose In order to prevent implant failure and secondary fracture dislocation, it is often recommended that patients perform partial weight-bearing after surgery of the lower extremity. Previous examinations showed that patients are often not able to follow these instructions. In this study, patients who had undergone surgery of the lower extremity were studied in order to analyze whether incorrect loading influenced the number and severity of complications. Methods Fifty-one patients were equipped with electronic shoe insoles, which measure loading and other parameters. The measurement period was 24 to 102 hours. Median duration of follow-up was 490 days. The primary outcome parameter was postoperative complications leading to revision surgery. Statistical analysis was performed using the chi-square and Fisher exact tests with significance set at a p < 0.05. Results Seven out of fifty-one patients had postoperative complications. Four wound complications, one implant failure, chronic instability after fracture of the tibia, and one implant loosening of a hip prosthesis were recorded. In total, 26 of 39 patients were not able to follow the postoperative instructions. Five of the twenty-six patients with difficulties in partial weight-bearing suffered a postoperative complication. In comparison, only 2 of the other 25 patients were affected. There was no statistically significant correlation between high weight-bearing and occurrence of complications (p = 0.29). Conclusion Most of the patients were unable to follow the surgeon’s instructions for partial weight-bearing. Excessive loading did not seem to influence the number and severity of postoperative complications, especially regarding implant failure. Therefore, we should continue with measurements and reevaluate the “partial weight-bearing doctrine”.

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Section: Discussionmentioning

confidence: 92%

Influence of Weight Bearing on Postoperative Complications after Surgical Treatment of the Lower Extremity

et al. 2022

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“…This need for greater effort may reduce patients’ compliance with rehabilitation protocols. Immediate, full weightbearing after locking plate osteosynthesis for partial articular proximal tibial fractures has been studied and recommended [ 22 – 24 ]. Thewlis et al [ 16 ] reported on the functional outcomes after surgery of 17 patients with either complete or incomplete articular fractures (AO types 41-B and C).…”

Section: Discussionmentioning

confidence: 99%

“…Their results showed no association between weightbearing and patient functional outcomes at 1 year. Williamson et al [ 24 ] showed that patients who progressed to immediate, full weightbearing after open reduction internal fixation neither lost reduction nor reported worse functional outcomes at 1 year compared with patients who maintained partial weightbearing for 6 weeks. Because patients self-regulate their weightbearing when allowed early, full, earlier weightbearing may be safe [ 16 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Williamson et al [ 24 ] showed that patients who progressed to immediate, full weightbearing after open reduction internal fixation neither lost reduction nor reported worse functional outcomes at 1 year compared with patients who maintained partial weightbearing for 6 weeks. Because patients self-regulate their weightbearing when allowed early, full, earlier weightbearing may be safe [ 16 , 24 ]. Although these results may appear to support an accelerated weightbearing protocol after open reduction and internal fixation of complex tibial plateau fractures, until now no biomechanical study has been published to support these results.…”

Section: Discussionmentioning

confidence: 99%

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Weightbearing after combined medial and lateral plate fixation of AO/OTA 41-C2 bicondylar tibial plateau fractures: a biomechanical study

Thamyongkit

Abbasi

Parks

et al. 2022

BMC Musculoskelet Disord

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Background Combined medial and lateral plate fixation is recommended for complex tibial plateau fractures with medial fragments or no cortical bone contact. Although such fixation is adequate to resist forces during range of motion, it may be insufficient to support immediate postoperative weightbearing. Here, we analyzed displacement, stiffness, and fixation failure during simulated full weightbearing of bicondylar tibial plateau fractures treated with combined medial and lateral locking plate fixation. Methods We used 10 fresh-frozen adult human cadaveric tibias and mated femurs. Osteotomies were performed with an oscillating saw and cutting template to simulate an AO Foundation and Orthopaedic Trauma Association (AO/OTA) 41-C2 fracture (simple articular, multifragmentary metaphyseal fracture). Specimens were anatomically reduced and stabilized with combined medial and lateral locking plates (AxSOS, Stryker, Mahwah, NJ). Specimens were loaded axially to simulate 4 weeks of walking in a person weighing 70 kg. The specimens were cyclically loaded from 200 N to a maximum of 2800 N. Then, if no failure, loading continued for 200,000 cycles. We measured displacement of each bone fragment and defined fixation failure as ≥5 mm of displacement. Construct stiffness and load at failure were calculated. Categorical and continuous data were analyzed using Chi-squared and unpaired t-tests, respectively. Results Mean total displacement values after 10,000 loading cycles were as follows: lateral, 0.4 ± 0.8 mm; proximal medial, 0.3 ± 0.7 mm; distal medial, 0.3 ± 0.6 mm; and central 0.4 ± 0.5 mm. Mean stiffness of the construct was 562 ± 164 N/mm. Fixation failure occurred in 6 of 10 specimens that reached 5 mm of plastic deformation before test completion. In the failure group, the mean load at failure was 2467 ± 532 N, and the mean number of cycles before failure was 53,155. After test completion, the greatest displacement was found at the distal medial fracture site (2.3 ± 1.4 mm) and lateral fracture site (2.2 ± 1.7 mm). Conclusions Although combined medial and lateral plate fixation of complex tibial plateau fractures provides adequate stability to allow early range of motion, immediate full weightbearing is not recommended.

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“…No consensus exists on whether to allow immediate weight bearing after osteosynthesis of a proximal tibial fracture or not. Recent observational studies have shown no increased risk of subsequent articular collapse after immediate weight bearing regardless of fracture type [ 13 , 14 ], suggesting immediate weight as safe post-operative management. The post-operative management in our department is in line with these studies though most surgeons lean towards a non-weight bearing regime, the more complex and comminuted the fracture is.…”

Section: Discussionmentioning

confidence: 99%

Highly impacted bone allograft may allow immediate weight bearing in tibial plateau fractures: A case report

Hare

Brand

Bloch

2020

Trauma Case Reports

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Introduction Proximal tibial fractures are common with an incidence of 10.2/100.000. Those displaced and involving the articular surface will often require surgical treatment. However, no consensus exists on whether to allow the patient early weight bearing or not. We developed a technique using structural bone chips, highly impacted under the articular surface, to permit immediate weight bearing after surgery. Patient The patient was a 44-year old male who suffered a lateral tibial plateau fracture (AO type 41B2). Intervention We used an anterolateral approach with an S-shaped incision. A small window in the tibia was made using an awl, and the articular surface was reduced under radiographic imaging. The bone allograft was prepared by splitting the frozen femoral head in quarters and then taking large pieces of bone with a bone rongeur forceps avoiding the cartilage. The large pieces of bone were gathered in a small tray and thereafter compressed into the drill guide insert. The drill guide filled with bone graft was then inserted into the tibia window and directed in the appropriate position guided by radiography. Hereafter, the bone graft was impacted under the articular surface with force using the appropriate trocar and a hammer, and the fracture was finally reduced. Finally, the fracture was fixated utilizing an angular stable plate. Outcome The patient was followed up one year postoperatively and allowed immediate weight bearing after surgery. No subsequent articular collapse occurred. Discussion In this case, we present a proximal tibial fracture with articular depression, which was surgically treated with a highly impacted bone allograft of large pieces and a locking plate. The patient was allowed immediate weight bearing and no subsequent articular collapse occurred.

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Immediate weight bearing after plate fixation of fractures of the tibial plateau

Cited by 31 publications

References 23 publications

Influence of Weight Bearing on Postoperative Complications after Surgical Treatment of the Lower Extremity

Influence of Weight Bearing on Postoperative Complications after Surgical Treatment of the Lower Extremity

Weightbearing after combined medial and lateral plate fixation of AO/OTA 41-C2 bicondylar tibial plateau fractures: a biomechanical study

Highly impacted bone allograft may allow immediate weight bearing in tibial plateau fractures: A case report

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