Management of Unicondylar Tibial Plateau Fractures: A Review

Daniel Warren, BS; Grayson Domingue, MD; John T. Riehl, MD

Disclosures

Curr Orthop Pract. 2022;33(1):85-93. 

In This Article

Postoperative Protocols

There is limited evidence in the literature to guide clinicians in postoperative management of TPF.[89,90] Although a range of management algorithms has been described in the literature, the most common regimen generally consists of nonweight-bearing (NWB) for 4 to 6 wk, partial weight-bearing (PWB) for another 4 to 6 wk, and a resulting time to full weight-bearing (FWB) of 9 to 12 wk.[90]

There is a consensus that early range-of-motion exercises improves outcomes after TPF.[90] Knee bracing after TPF is uncommon, with Arnold et al.[90] finding only 30% of studies recommending bracing postoperatively. The most controversial area of postoperative management is the timing and intensity of weight-bearing. As noted above, 4 to 6 wk of NWB is a common regimen but recent literature provides support for a more aggressive weight-bearing protocol. Kalmet et al.[91] reported that a permissive weight-bearing-as-tolerated regimen immediately after surgery was associated with an earlier return to FWB status with no increase in the rate of complications and equivalent function outcome scores compared NWB protocols. Unicondylar TPF in particular may be more amenable to early weight-bearing, with no increase in the rate of complications of these fracture patterns after an accelerated weight-bearing protocol.[90] Multiple studies that evaluated radiographic outcomes and fracture displacement in early weight-bearing protocols in the setting of unicondylar TPF treated with ORIF have demonstrated these fracture patterns are stable even with early weight-bearing and thus recommend early weight-bearing protocols to capture the benefits of an early return to FWB status.[72,92–94]

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