Tibial Plateau Fracture — Non-Operative Tibial Plateau Fracture

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

NWB with crutches x6 wks (TTWB allowed for pivot transfers if indicated) Phase I; PWB begins 25% BW at wk6-8, increasing 25% approximately every 3 days, one crutch possible at wk 7.5, off crutches by wk 8-9

Key Restrictions

Brace in full extension x6 wks; avoid running/impact activity through wk 10; knee elevated above heart first 3-5 days

Timeline & Phases

Phase I (wks 0-1): ice/modalities for pain/inflammation, crutches NWB x6 wks (TTWB for pivot transfers if indicated), brace in full extension x6 wks, elevate knee above heart first 3-5 days, patella mobility drills, full passive/active knee ROM exercises, quadriceps setting focusing on VMO restoration, multi-plane open kinetic chain SLR, gait training with crutches (NWB); Phase II, Progressive Stretching and Early Strengthening (wks 1-6): maintain Phase I program, continue inflammation-control modalities, global LE stretching, core stability reintegration exercises, closed kinetic chain multi-plane hip strengthening on uninvolved side, manual LE PNF patterns, proprioception drills for neuromuscular control, multi-plane ankle strengthening; Phase III, Strengthening and Proprioceptive Phase (wks 6-10): modalities as needed, continue Phase II exercises, begin stationary bike and pool exercise program once incisions healed, begin PWB at 25% BW (wk6-8) increasing 25% approximately every 3 days, progress to one crutch ~wk 7.5, wean off crutches by wk 8-9; wks 9-10: normalize gait pattern, advance stationary bike program, begin treadmill walking and elliptical trainer (avoid running/impact), initiate closed kinetic chain exercises progressing bilateral to unilateral, initiate proprioception training; Phase IV, Advanced Strength and Initiation of Plyometric Drills (wks 10-20): wks 10-16 initiate gym strengthening bilateral progressing to unilateral (leg press, heel raises, hamstring curls, squats, lunges, knee extensions 30-0 deg progressing to full range as PF arthrokinematics normalize); wks 16-20 continue advanced strengthening, begin functional cord program, begin pool running program progressing to land as tolerated; Phase V, Return to Sport Functional Program (wks 20-24): follow-up exam with physician, sport-specific multi-directional drills and bilateral plyometric activity progressing to unilateral as tolerated, continue aggressive LE strengthening/cardiovascular training/flexibility, sports test for return to play

Notes

OSMS Rehabilitation Guidelines; non-operative management of tibial plateau fracture; 5-phase, 24-week protocol