Weight bearing after surgical treatment of tibial plateau fractures - an international survey of orthopaedic trauma surgeons.

Abstract

The optimal postoperative weight-bearing regimen for tibial plateau fractures (TPF) remains a topic of debate. It ranges from non- or touch down- weight bearing between 2-12 weeks. More recent studies suggest that early weight-bearing may not result in any loss of reduction or hardware failure. To describe orthopedic surgeons' preferences for postoperative regimens and factors that influence their decision making in relation to weight-bearing status after treating TPF. A web-based survey was developed by the authors regarding tibial plateau fractures. Participants were asked different questions about timing of weight bearing after osteosynthesis and factors that influenced the surgeon's decision-making process for 3 unicondylar and 3bicondylar tibial plateau fractures. A web-based survey was developed and 151 surgeons answered our survey. 82 % were men and 62 % of respondents treated > seven tibial plateau fractures per year. In unicondylar fractures 19 % recommended full weight bearing and 81 % recommended restricted weight-bearing. In bicondylar fractures 89 % recommended restricted weight-bearing and 11 % full weight bearing. Restricted weight bearing was recommended for 2, 4, 6, 8, 10 or 12 weeks depending on the surgeon's preference. 73 % of the surgeons stated that the sense of stability in their own construction affects their postoperative weight-bearing plan and in 45 % the regimen was based on "gut feeling". Responders believed they get a stable osteosyntehsis in only 57 % of their own fixations and 48 % responded that they do not believe patients are following the postoperative weight bearing plan. Our survey study demonstrated variability among orthopedic surgeons regarding postoperative weight-bearing in tibial plateau fractures. Further research is required to understand the stability of tibial plateau fractures and quantify whether we can allow patients to weight bear earlier safely.