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Braun BJ, Huss C, Heimueller S, Klein M, Herath SC, Ruebe C, Pohlemann T, Niewald M. Should I Stay or Should I Go? A Prospective, Blinded Study Comparing the Diagnostic Capability of Dynamic and Stationary Pedobarography in Plantar Fasciitis. J Foot Ankle Surg 2019; 57:1181-1185. [PMID: 30368429 DOI: 10.1053/j.jfas.2018.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Indexed: 02/03/2023]
Abstract
The aim of this study was to determine the diagnostic capability of a dynamic gait analysis insole and compare its ability to detect clinical correlations to a common stationary analysis tool. Twenty-five patients with chronic plantar fasciitis were included in this prospective, blinded, diagnostic study. Conventional, stationary gait analysis on a force plate on an even surface and continuous dynamic pedobarography on a standardized course consisting of different gait tasks were performed and correlated to the disease severity. Mean patient age was 53.6 (range 41 to 68) years, with a mean pain level of 6.1 (range 4 to 10) on the Visual Analogue Scale and a calcaneodynia score of 48.7 (range 33 to 66). Significant correlations were seen between several dynamic gait values and clinical scoring: cadence (rs = 0.56, p = .004), stance time (rs = -0.6, p = .002), center-of-pressure velocity (rs = 0.44, p = .046), and double support time (rs = 0.42, p = .042). No significant correlations were seen between any force plate gait analysis values and clinical scoring. In this study setting, dynamic gait analysis was able to identify clinically relevant correlations to plantar fasciitis disease severity that standard force plate measurements could not.
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Affiliation(s)
- Benedikt J Braun
- Surgeon, Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Hamburg, Germany.
| | - Christine Huss
- Medical Student, Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Hamburg, Germany
| | - Sina Heimueller
- Medical Student, Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Hamburg, Germany
| | - Moritz Klein
- Surgeon, Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Hamburg, Germany
| | - Steven C Herath
- Surgeon, Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Hamburg, Germany
| | - Christian Ruebe
- Professor and Radiation Oncologist, Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Hamburg, Germany
| | - Tim Pohlemann
- Professor and Surgeon, Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Hamburg, Germany
| | - Marcus Niewald
- Professor and Radiation Oncologist, Department of Radiotherapy and Radiation Oncology, Saarland University Hospital, Hamburg, Germany
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Smeeing DPJ, Houwert RM, Briet JP, Groenwold RHH, Lansink KWW, Leenen LPH, van der Zwaal P, Hoogendoorn JM, van Heijl M, Verleisdonk EJ, Segers MJM, Hietbrink F. Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial. Eur J Trauma Emerg Surg 2018; 46:121-130. [PMID: 30251154 PMCID: PMC7026225 DOI: 10.1007/s00068-018-1016-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/20/2018] [Indexed: 12/14/2022]
Abstract
Purpose The goal of this study was to assess if unprotected weight-bearing as tolerated is superior to protected weight-bearing and unprotected non-weight-bearing in terms of functional outcome and complications after surgical fixation of Lauge-Hansen supination external rotation stage 2–4 ankle fractures. Methods A multicentered randomized controlled trial was conducted in patients ranging from 18 to 65 years of age without severe comorbidities. Patients were randomized to unprotected non-weight-bearing, protected weight-bearing, and unprotected weight-bearing as tolerated. The primary endpoint of the study was the Olerud Molander Ankle Score (OMAS) 12 weeks after randomization. The secondary endpoints were health-related quality of life using the SF-36v2, time to return to work, time to return to sports, and the number of complications. Results The trial was terminated early as advised by the Data and Safety Monitoring Board after interim analysis. A total of 115 patients were randomized. The O’Brien–Fleming threshold for statistical significance for this interim analysis was 0.008 at 12 weeks. The OMAS was higher in the unprotected weight-bearing group after 6 weeks c(61.2 ± 19.0) compared to the protected weight-bearing (51.8 ± 20.4) and unprotected non-weight-bearing groups (45.8 ± 22.4) (p = 0.011). All other follow-up time points did not show significant differences between the groups. Unprotected weight-bearing showed a significant earlier return to work (p = 0.028) and earlier return to sports (p = 0.005). There were no differences in the quality of life scores or number of complications. Conclusions Unprotected weight-bearing and mobilization as tolerated as postoperative care regimen improved short-term functional outcomes and led to earlier return to work and sports, yet did not result in an increase of complications. Electronic supplementary material The online version of this article (10.1007/s00068-018-1016-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diederik Pieter Johan Smeeing
- Department of Surgery, St. Antonius Hospital Nieuwegein, PO Box 2500, 3430 EM Nieuwegein, The Netherlands
- Utrecht Traumacenter, Utrecht, The Netherlands
| | - Roderick Marijn Houwert
- Utrecht Traumacenter, Utrecht, The Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Paul Briet
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Rolf Hendrik Herman Groenwold
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Peer van der Zwaal
- Department of Orthopaedics, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | | | - Mark van Heijl
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | | | | | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Kammerlander C, Pfeufer D, Lisitano LA, Mehaffey S, Böcker W, Neuerburg C. Inability of Older Adult Patients with Hip Fracture to Maintain Postoperative Weight-Bearing Restrictions. J Bone Joint Surg Am 2018; 100:936-941. [PMID: 29870444 DOI: 10.2106/jbjs.17.01222] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For elderly trauma patients, a basic goal is early mobilization, as immobilization can trigger various complications, such as venous thromboembolism, pneumonia, urinary tract infections, and pressure ulcers. Although partial weight-bearing has been shown to significantly increase mortality compared with unrestricted weight-bearing, it remains a frequent recommendation of aftercare following lower-extremity fracture fixation. METHODS An insole force sensor was used to measure true postoperative weight-bearing by patients ≥75 years of age treated for hip fracture compared with patients 18 to 40 years of age treated for ankle fracture. Both groups were instructed to maintain partial weight-bearing on the affected limb (≤20 kg) postoperatively. Following standardized physiotherapy training, gait analysis was performed. RESULTS None of the patients in the elderly test group were able to comply with the weight-bearing restriction as recommended. We found that 69% (11 of 16) of the patients exceeded the specified load by more than twofold, whereas significantly more patients in the younger control group (>75% [14 of 18]) achieved almost the entire weight-bearing restriction (p < 0.001). Only 1 of the elderly patients was able to comply with the predetermined weight-bearing restriction, and only for a short period of time. In comparison, significantly more patients in the control group (89% [16 of 18]; p < 0.001) maintained the partial load for nearly the entire time during gait analysis. CONCLUSIONS Elderly patients seem to be unable to maintain weight-bearing restrictions. As early mobilization of geriatric trauma patients is an important element for a successful rehabilitation, the directive of postoperative partial weight-bearing for these patients should be abandoned. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christian Kammerlander
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany.,Department of Trauma Surgery, Medical University, Innsbruck, Austria
| | - Daniel Pfeufer
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Leonard Adolf Lisitano
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Stefan Mehaffey
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Carl Neuerburg
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
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Patient-related outcomes after proximal tibial fractures. INTERNATIONAL ORTHOPAEDICS 2018; 42:2925-2931. [PMID: 29627849 DOI: 10.1007/s00264-018-3920-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/26/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of the study was to assess patient-related outcomes at short-term follow-up in patients with a proximal tibial fracture. METHODS One hundred sixteen patients (119 fractures) treated at our institution during 2012 were retrospectively reviewed. Follow-up was 1.6 (SD ± 0.4) years post-injury, including the short musculoskeletal function assessment and visual analog scale for pain and satisfaction. Fractures were classified by the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification and divided in two groups: simple and complex. RESULTS Patients with simple fractures reported lower short musculoskeletal function assessment indices and less pain on visual analog scale than those with complex fractures. No difference was found in short musculoskeletal function assessment between surgically and non-surgically treated patients. Non-surgically treated patients reported less pain and were more satisfied. The overall complication rate was 30 (25%) of 119 fractures, with surgical treatment carrying a 7.0 (95% CI: 1.5-34) odds ratio for local complications. CONCLUSIONS This study provides information about realistic prognosis after proximal tibial fractures. The finding that surgically treated patients had similar outcomes to non-surgically treated ones may indicate that surgery improves the prognosis of complex fractures to a level comparable to the prognosis of less severe ones. However, the risk of complications after surgery should guide treatment when surgery is not clearly indicated.
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De Boer AS, Van Lieshout EMM, Van Moolenbroek G, Den Hartog D, Verhofstad MHJ. The effect of time to post-operative weightbearing on functional and clinical outcomes in adults with a displaced intra-articular calcaneal fracture; A systematic review and pooled analysis. Injury 2018; 49:743-752. [PMID: 29496317 DOI: 10.1016/j.injury.2018.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Post-operative weightbearing guidelines for displaced intra-articular calcaneal fractures (DIACF) have been pragmatically developed in the past, however hardly adapted to current health care insights. A period of six to nine weeks of non-weightbearing is usually recommended. It is unknown whether an earlier start of weightbearing is advisable. OBJECTIVES The primary aim was to evaluate the effect of time to post-operative weightbearing on Böhler's angle. Secondary aims were to determine the effect on functional outcome (e.g., The American Orthopedic Foot and Ankle Society Scale), post-operative pain score, complications (e.g., infections, nonunion, implant removal), and revision surgeries. Finally, the effect of bone void filling on these outcomes was investigated. DATA SOURCE A literature search was performed on January 24, 2017 in the Cochrane Library, Medline Ovid, Embase, Web of Science, Google Scholar, and CINAHL. LITERATURE SELECTION Studies reporting on operatively treated patients with a DIACF and time to weightbearing were eligible for inclusion. Studies were excluded when not reporting primary data, solely reporting on open fractures, bilateral fractures, or polytrauma patients. Based upon the time to starting partial weightbearing, patient cohorts were stratified into very early (0-4 weeks), early (4-6 weeks), intermediate (6-8 weeks), or late (8-12 weeks) start of partial weightbearing. DATA EXTRACTION Two investigators extracted data independently using a predefined data sheet. RESULTS After applying exclusion criteria, 72 studies remained eligible for analysis. Böhler's and Gissane's angles, calcaneal height, AOFAS, pain scores, and complications had overlapping confidence intervals in all weightbearing groups. CONCLUSION The adverse sequelae which are assumed to be associated with starting partial weightbearing already within six weeks after internal fixation of calcaneal fractures, is not supported by literature data. This systematic review suggests that early weightbearing does not result in impaired outcomes compared with more conservative weightbearing regimes.
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Affiliation(s)
- A Siebe De Boer
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Gerson Van Moolenbroek
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Dennis Den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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Veilleux LN, AlOtaibi M, Dahan-Oliel N, Hamdy RC. Incidence of knee height asymmetry in a paediatric population of corrected leg length discrepancy: a retrospective chart review study. INTERNATIONAL ORTHOPAEDICS 2018; 42:1979-1985. [PMID: 29387916 DOI: 10.1007/s00264-018-3794-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of the study is to provide a methodology to quantify knee height asymmetry (KHA) and to establish the incidence of knee height asymmetry in a patient population visiting the limb length discrepancy clinic in a paediatric-orthopaedic hospital centre. METHOD A retrospective chart review was performed on all patients who attended the limb length discrepancy clinic and underwent corrective surgery at the Shriners Hospital for Children-Canada from December 2009 to December 2015. Full-standing anteroposterior radiographs were used to measure pre- and post-surgery limb length discrepancy and knee height asymmetry for 52 individuals included in the study. RESULTS Sixty-seven percent of the studied population had a KHA of 20 mm or less, 25% had a KHA between 20 and 40 mm, and 8% had a KHA of over 40 mm. The average KHA preoperatively for all 52 individuals was 17 ± 14 mm (range 0-59 mm), which represents roughly 2.5% of total limb length. There was a 3-mm non-significant reduction in KHA size between pre-and post-operative states (p = 0.22). CONCLUSION The current study provides a method to quantify knee height asymmetry. Using this method, it was shown that knee height asymmetry is frequent in youth with limb length discrepancy in both pre- and post-corrective surgery states. The relatively high incidence of knee height asymmetry highlights the importance to investigate the impact of knee height asymmetry in youth living with a limb length discrepancy.
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Affiliation(s)
- Louis-Nicolas Veilleux
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada. .,Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1, Canada.
| | - Mohammed AlOtaibi
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada.,Faculty of Graduate Studies, McGill University, 845 Sherbrooke Street West, Montreal, Quebec, H3A 0G4, Canada.,King Fahad Medical City, Al Mukarramah Branch Rd, As Sulimaniyah, Riyadh, Makkah, 11525, Saudi Arabia
| | - Noémi Dahan-Oliel
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada.,Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1, Canada
| | - Reggie C Hamdy
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada.,Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1, Canada
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Braun BJ, Pelz P, Veith NT, Rollmann M, Klein M, Herath SC, Holstein JH, Pohlemann T. Long-term pathological gait pattern changes after talus fractures — dynamic measurements with a new insole. INTERNATIONAL ORTHOPAEDICS 2018; 42:1075-1082. [DOI: 10.1007/s00264-017-3720-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 12/10/2017] [Indexed: 12/23/2022]
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