Weight Bearing Decisions After Tibial Plateau Fractures: A Literature Review Based on Clinical Perspective for Physiotherapists in India

BACKGROUND AND PURPOSE: Physiotherapists managing tibial plateau fracture rehabilitation in India lack India-specific guidance on weight-bearing progression. Existing protocols reflect high-income country settings with assumed physiotherapy access and consistent implant quality-conditions that do not reflect Indian clinical realities. A persistent problem in Indian practice is the conflation of early mobilization with early weight bearing, leading to rehabilitation mismanagement in both directions. This clinical perspective synthesizes available Indian evidence and proposes a practical, physiotherapist-applicable framework for weight-bearing decision-making after tibial plateau fractures. METHODS: Design: literature review study with structured narrative synthesis as the analytical method, supplemented by explicit author perspective. A search of PubMed, IndMED, and Google Scholar (2013-2025) identified 10 Indian studies on rehabilitation after tibial plateau fractures, comprising one pilot randomized controlled trial, prospective and retrospective cohort studies, one case series, a narrative review, and one case report. Adult patients (aged ≥ 18 years) with tibial plateau fractures managed in Indian clinical settings were included. Opinion-based content is explicitly identified throughout. RESULTS: Early knee mobilization was consistently associated with improved functional outcomes across all study types, independent of weight-bearing timing. Early partial weight bearing appeared feasible in patients with stable fixation, good bone quality, and supervised physiotherapy, based primarily on observational evidence and one underpowered pilot trial. Delayed weight bearing was appropriate for comminuted fractures, osteoporotic bone, and settings with limited physiotherapy supervision. Physiotherapy access was the primary real-world determinant of rehabilitation safety across all included studies. CONCLUSIONS: Early mobilization should be universal; early weight bearing must be criterion-based and selective. A fixation-dependent, three-phase physiotherapist-guided rehabilitation framework is proposed for Indian clinical settings, explicitly addressing supervision availability, bone quality variability, and cultural functional demands. Multicenter Indian studies with physiotherapy-led outcome measures are urgently required.