Effect of early weight bearing program with conventional physiotherapy on functional outcomes in surgically treated proximal tibia fracture-A Pilot Randomized Controlled Trial.

Objective:

1.To compare the effect of early weight bearing in addition to conventional post-operative rehabilitation versus restricted weight bearing along with conventional physiotherapy on pain, range of motion, quadriceps isometric muscle strength & patient relevant outcomes in patients with post-operative tibial plateau fractures at various intervals i.e. at discharge, after 6 weeks and 12 weeks after the surgery.

2. To investigate the effect of early weight bearing on functional outcomes of pain, range of motion, quadriceps isometric muscle strength and patient relevant outcomes in patients with postoperative tibial plateau fractures at various intervals i.e. at discharge, after six weeks and 12 weeks compared to baseline.

3. To investigate the effect of restricted weight bearing on functional outcomes of pain, range of motion, quadriceps isometric muscle strength and patient relevant outcomes in patients with postoperative tibial plateau fractures at various intervals i.e. at discharge, after six weeks and 12 weeks compared to baseline.

4. To observe the adverse effects, (fixation failure, loss of reduction or joint depression, non- union) of early weight bearing on patients with postoperatively managed tibial plateau fracture.

Design: A Pilot Randomized Controlled Trial

Study Setting: Tertiary Care Hospital

Procedure:

Patients with Post-operative Day 3 of tibial plateau fractures above the age of 18 years will be taken. Eligible patients will be included for the study. Patients will be divided in two groups Group I Weight bearing and Group II Restricted weight-bearing group. Before collection of the data Informed written and verbal consent will be taken from all the patients. Assessment of Knee joint including pain intensity by NPRS and Range of Motion using universal goniometer, quadriceps isometric muscle strength by push-pull dynamometer, Knee Injury and Osteoarthritis Outcome Score (KOOS), post-operative X-ray will be checked on post-operative Day-3 and will be reassessed at discharge , after 6 weeks and after 12 weeks. Adherence will be checked after 6 weeks and 12 weeks by Exercise Adherence Rating Scale (EARS). Group I will be given Early weight bearing along with conventional physiotherapy whereas Group II will be given restricted weight bearing along with conventional physiotherapy.

Early weight bearing Protocol:

Day 3 – Till Discharge: Patient will be made to walk for 10m in a hallway. Partial weight bearing will be given with touchdown weight bearing (as tolerated by the patient) and will be increased by 25% approximately as tolerated by the patient with the use of assistive aid.

Discharge - 6 weeks: Patient will be asked to continue the weight bearing as tolerated and progress to partial weight bearing (50%) as tolerated with the use of assistive aid.

6 weeks – 12 weeks: Patient will be asked to progress from partial weight bearing as tolerated to partial weight bearing up to 75% with the use of assistive aid.

Conventional Physiotherapy Protocol:

These will include bedside exercises consisting of improving range of motion, increasing strength with progression to balance training.