Effect of Immediate Weight-Bearing on Patterns of Gait and Falling Risk after Tibial Plateau Fractures: A retrospective Study

Abstract

Background and aim: Treatment of tibial plateau fractures are challenging due to changes in gait and increased the risk for falls. Early weight bearing may affect outcome. However, there was no consensus on early weight bearing. Thus, this study was designed as a retrospective study to determine the differences in gait patterns and risk of falling after surgery for fixation of tibial plateau fractures (grades I to IV Schatzker classification).

Methodology: We collected data about gait patterns and the risk of falling after surgery for tibial plateau fractures. The study included data of 122 patients.  All were treated by open reduction and internal fixation with locking plates and screws. Patients were categorized into two equal groups. The first of immediate weight bearing and the second for non-weight bearing group. The final outcome was determined at the end of the third month after surgery. This included data about isometric muscle strength, mobility and balance (at the hip), calculation of Tinetti Performance Oriented Mobility Assessment (POMA) score and fall risk was graded as (minimal if POMA > 23; moderate for scores between 19 and 23, and high for scores lower than 19). 

Results: Most patients were in their fifties (the age ranged between 21 to 60 years). Males were predominant in both groups (73.8% and 67.2% in A and B groups).  Both groups were comparable regarding patient age, sex, body mass index (BMI), fracture grade and type. The weight bearing group was associated with significant increase of step symmetry, step continuity, path, trunk stability, walking stance, gait, balance and total POMA scores. The gait score, balance score and total POMA scores were 11.049±1.986, 14.672±2.631 and 25.721±3.271 in weight bearing group, compared to 9.246±2.078, 11.098±2.406 and 20.409±3.153, successively. The risk of fall was significantly different between weight bearing than non-weight bearing groups. It was high, medium and minimal in 0.0%, 23.0% and 77.0% respectively in wight bearing, compared to 32.8%, 49.2% and 18.0% respectively in the non-weight bearing group (p < 0.001). The fall risk was significantly correlated with stride length, velocity, path score, gait and balance scores.

Conclusion: The immediate weight bearing after surgical treatment of tibial plateau fractures is associated with reduced risk of fall and significant improvement of spatiotemporal gait parameters.