Tibial Plateau Fracture Surgery
Physical Therapy Protocol
Tibial Plateau Fracture: Open Reduction Internal Fixation (ORIF)
Physical Therapy Protocol
Phase I – Maximum Protection (0 to 1 Week)
0 to 1 Week:
- Ice and modalities to reduce pain and inflammation.
- Non-weight bearing (NWB) with crutches for 12 weeks.
- Brace in full extension except during therapy sessions.
- Elevate the leg above the heart for the first 3 to 5 days.
- Patella mobility drills.
- Gait training focusing on NWB restoration.
Phase II – Progressive Stretching and Early Strengthening (Weeks 1 to 6)
Weeks 1 to 6:
- Continue with the program outlined in Phase I.
- Use modalities to control inflammation.
- Begin gentle range of motion (ROM), goal to exceed 90° of knee flexion by 4 weeks.
- Closed kinetic chain multi-plane hip strengthening on the uninvolved side.
- Proprioception drills emphasizing neuromuscular control.
- Multi-plane ankle strengthening.
Phase III – Strengthening and Proprioceptive Phase (Weeks 6 to 12)
Weeks 6 to 12:
- Modalities as needed.
- Continue with Phase II exercises as indicated.
- Emphasis on achieving and maintaining full ROM.
- Begin stationary bike and light strengthening exercises.
- Initiate weight-bearing as tolerated, progressing gradually.
Phase IV – Advanced Strengthening and Initiation of Plyometric Drills (Weeks 12 to 20)
Weeks 12 and Onward:
- Begin partial weight bearing at 25% of body weight and increase by 25% per week.
- Gradually progress to one crutch as tolerated, eventually weaning off crutches.
- Normalize gait pattern once bearing full weight.
- Initiate closed kinetic chain exercises progressing from bilateral to unilateral movements.
- Begin proprioceptive training exercises.
Phase V – Full Return to Activity (Weeks 20 and Beyond)
Weeks 20 and Onward:
- Full return to activity as tolerated.
- Continue strengthening and proprioceptive exercises.
- Begin sport-specific drills and progressive load-bearing exercises.
Patient Education
- Emphasize the importance of following the weight-bearing guidelines to avoid complications.
- Instruct patients on proper bracing, gait training, and how to manage swelling with elevation and cryotherapy.
- Educate on gradual return to activity, with a focus on avoiding high-impact activities until cleared.
Red Flags
- Unusual pain, increased swelling, or discomfort should be reported to the healthcare provider.
- Any difficulties with weight-bearing progression or abnormal gait pattern should be addressed immediately.
- Persistent or increasing joint stiffness, particularly after the 12-week mark, should be evaluated for potential complications.