Title : Early versus delayed weight bearing following tibial plateau fracture surgery: A systematic review and meta analysis
Abstract:
Tibial plateau fractures are complex injuries affecting the knee’s load-bearing surface, commonly requiring surgical fixation. Traditional rehabilitation protocols favor delayed weight-bearing (DWB) to avoid complications, while recent evidence suggests early weight-bearing (EWB) may enhance functional recovery without increasing risk. This systematic review and meta-analysis aimed to compare outcomes between early and delayed weight-bearing following surgical treatment of tibial plateau and shaft fractures. A comprehensive search across multiple databases identified 10 eligible studies comparing EWB versus DWB in adult patients. Data on postoperative pain, healing time, delayed union, non-union, and functional outcomes were extracted. Meta-analyses were conducted using RevMan 5.4, and methodological quality was assessed using the Downs and Black checklist. Across 940 patients, early weight-bearing was not associated with increased pain, delayed union, or non-union. Meta-analysis showed no statistically significant differences in VAS pain scores (SMD = 0.06; p = 0.89), time to union (SMD = -0.45; p = 0.32), delayed union (OR = 0.40; p = 0.25), or non-union (OR = 0.14; p = 0.10). Studies reported earlier recovery, improved range of motion, and similar complication rates in EWB groups. Early weight-bearing after tibial fracture fixation is safe and may accelerate functional recovery without increasing risk. However, heterogeneity in fracture types and protocols highlights the need for individualized strategies and further high-quality research.
