Immediate Unrestricted Assisted Full Weight-Bearing After Bicondylar Tibial Plateau Fixation: A Case Series

High-energy bicondylar tibial plateau fractures of Schatzker types V and VI are conventionally managed, after open reduction and internal fixation, with 6-12 weeks of restricted weight-bearing, out of concern for loss of reduction and articular collapse. Emerging evidence questions whether this restriction is necessary. Reports of immediate weight-bearing specifically after fixation of these most unstable bicondylar patterns remain scarce, as most comparative studies pool this subtype within mixed cohorts. We present three consecutive patients (two men and one woman; mean age: 54 years; all of North Indian ethnicity) with closed, high-velocity Schatzker type V-VI tibial plateau fractures sustained in road traffic accidents. Each was treated with open reduction and internal fixation using a dual-plate or three-plate construct, with allograft impaction of the metaphyseal void created after the elevation of the depressed articular fragments. In departure from the conventional restricted protocol, each patient was mobilised to full weight-bearing as tolerated from the first postoperative day, using a walking aid for balance rather than for offloading, with early active range-of-motion exercises and no brace. At six weeks, all three patients had achieved independent ambulation with a walking aid, knee flexion beyond 90 degrees, no pain during activities of daily living, and a clinically acceptable gait. Follow-up radiographs showed no loss of fixation, screw cut-out, or articular collapse, and no patient sustained a wound complication, infection, or revision surgery. Immediate unrestricted full weight-bearing after stable plate fixation of Schatzker type V-VI tibial plateau fractures appears safe and may accelerate functional recovery. These observations are concordant with recent randomised and comparative literature and are underpinned by a coherent bone-biological rationale in which physiological loading promotes rather than jeopardises union. This report supports a considered shift away from routine prolonged non-weight-bearing towards individualised, stability-guided early mobilisation, even for the most unstable bicondylar patterns, provided the fixation construct is intraoperatively judged sound. Larger prospective comparative studies are needed to confirm these findings and refine patient selection.