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Canseco K, Becker BM, Muscott RK, Schmeling GJ, Fritz JM. Gait and strength assessment following surgical repair by intramedullary nailing of isolated tibial shaft fracture. J Orthop Res 2024; 42:618-627. [PMID: 37804214 DOI: 10.1002/jor.25704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
The objective of the study was to evaluate the long-term strength and gait outcomes after intramedullary nailing of isolated tibial diaphyseal fractures. This retrospective cohort study was conducted at an academic Level I trauma center. Fifteen participants with isolated tibial diaphyseal fractures (OTA/AO 42) at least 2 years postoperative from intramedullary nailing (IMN) provided informed consent. The average age was 40 ± 14 (range, 24-69); there were nine men and six women. Knee flexion-extension strength data were collected. Temporal-spatial, kinematic, and kinetic gait parameters were measured and compared to historic control data. Participants completed the SF-36 and shortened musculoskeletal function assessment questionnaires. The mean length of follow-up between surgery and gait analysis was 6 ± 2 years. The fractured limb demonstrated deficits in quadriceps strength between 9.8% and 23.4% compared to the unaffected limb. Temporal-spatial parameters revealed slower walking speed, shorter stride length, decreased cadence, and shorter single-limb support time in the fractured limb. Altered kinematic and kinetic findings included a knee extension shift during stance, with an increased knee flexor moment demand and decreased total knee power during loading and midstance. These findings represent deficits in concentric and eccentric knee extensor activity. Additionally, the fractured limb demonstrated decreased ankle dorsiflexion during stance and diminished ankle push-off power. Long-term outcomes after IMN of tibial diaphyseal fractures demonstrate decreased quadriceps strength and altered gait parameters that may have implications to the high incidence of knee and ankle pain in the fractured limb.
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Affiliation(s)
- Karl Canseco
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Brittany M Becker
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rachel K Muscott
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
- Department of Orthopaedic Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Orthopedic Surgery, Aurora Health Care, Hartford, Wisconsin, USA
| | - Gregory J Schmeling
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Jessica M Fritz
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
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Wang Y, Qi Y, Ma B, Wu H, Wang Y, Wei B, Wei X, Xu Y. Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases. Front Bioeng Biotechnol 2024; 12:1303035. [PMID: 38456008 PMCID: PMC10919227 DOI: 10.3389/fbioe.2024.1303035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Walking is an indispensable mode of transportation for human survival. Gait is a characteristic of walking. In the clinic, patients with different diseases exhibit different gait characteristics. Gait analysis describes the specific situation of human gait abnormalities by observing and studying the kinematics and dynamics of limbs and joints during human walking and depicting the corresponding geometric curves and values. In foot and ankle diseases, gait analysis can evaluate the degree and nature of gait abnormalities in patients and provide an important basis for the diagnosis of patients' diseases, the correction of abnormal gait and related treatment methods. This article reviews the relevant literature, expounds on the clinical consensus on gait, and summarizes the gait characteristics of patients with common ankle and foot diseases. Starting from the gait characteristics of individuals with different diseases, we hope to provide support and reference for the diagnosis, treatment and rehabilitation of clinically related diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Yongsheng Xu
- Orthopedic Center (Sports Medicine Center), Inner Mongolia People’s Hospital, Hohhot, China
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Chen J, Wu T, Liu S, Guo Y. Rehabilitation effect of standing bed combined with early anti-gravity running table training on ankle fracture. Sci Rep 2024; 14:3582. [PMID: 38351120 PMCID: PMC10864343 DOI: 10.1038/s41598-024-52882-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
To explore the clinical effect of standing bed combined with early anti-gravity running table training in the healing and functional recovery of anterior rotation external rotation ankle fractures. Fifty-two patients with ankle fractures of degree III or degree IV of PER admitted to Pingle Orthopaedic and Traumatology Hospital of Shenzhen City between September 2021 and January 2023 were selected for observation, and they were divided into 26 cases in each group according to the method of randomised numerical table into the control group and the observation group. The patients in the control group started the routine rehabilitation treatment on the 1st day after operation, and in the 0-2 weeks after operation, the affected limb was elevated and ankle pump training was carried out; in the 3-6 weeks after operation, joint mobility training, strength training and soft tissue release were carried out; and in the 6-8 weeks after operation, weight-bearing training was increased. The observation group added standing bed training on the 7th postoperative day and anti-gravity running table training on the 28th postoperative day on the basis of the treatment protocol of the control group. Bone density, ankle mobility and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, pain, ankle mobility and swelling evaluations were compared between the 2 groups before and after 8 weeks of treatment, and the quality scores of bone scabs were compared between the 2 groups after 4 weeks of treatment. There was no statistical significance in the comparison of the items between the two groups before treatment (all P > 0.05), and the difference in the bone scab quality score was not statistically significant after 4 weeks of treatment (P > 0.05), and after 8 weeks of treatment, the bone scab quality score, bone mineral density and AOFAS scores, pain, ankle mobility, and evaluations were higher than those of the control group (all P < 0.05), and there was no significant difference in the degree of swelling (P > 0.05). Standing bed combined with early anti-gravity running table training applied to postoperative patients with PER III or IV degree ankle fracture can reduce the degree of pain and improve the ankle joint function.
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Affiliation(s)
- JiaWei Chen
- Hunan Mechanical Electrical Polytechnic, Changsha, 410000, Hunan, China
| | - TianYu Wu
- The People's Liberation Army Joint Logistic Support Force Sanya Rehabilitation and Recuperation Center, Sanya, 572000, Hainan, China.
| | - Shuigen Liu
- Department of Rehabilitation, Shenzhen Pingle Orthopedic Hospital and Shenzhen Pingshan Traditional Chinese Medicine Hospital, Shenzhen, 518000, Guangdong, China
| | - Ying Guo
- Qiongzhong People's Hospital of Li and Miao Autonomous County, Qiongzhong County, 572923, Hainan, China
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Brightwell BD, Van Wyngaarden JJ, Samaan MA, Matuszewski PE, Jacobs CA, Noehren B. Factors Associated With Long-Term Quadriceps Muscle Function After Surgical Fixation of Lower Extremity Fractures. Phys Ther 2023; 103:pzad108. [PMID: 37581587 PMCID: PMC11009693 DOI: 10.1093/ptj/pzad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/18/2023] [Accepted: 06/12/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE The long-term performance of the quadriceps femoris muscle and physical function following surgical repair of a lower extremity fracture remains largely undefined. The purpose of this study was to investigate between-limb differences in quadriceps performance 12 months after surgical fixation of a lower extremity fracture. It was hypothesized that the injured limb would be significantly weaker, have a lower rate of torque development (RTD), and that there would be a reduced step-down performance compared to the uninjured limb 12 months after surgery. Additionally, this study sought to identify demographic, surgical, and psychological factors associated with poor quadriceps function 12 months after surgery. METHODS Quadriceps performance was measured bilaterally in 95 participants (49 female), aged 42 (SD = 14.5) years, 12 months after surgical fixation of a lower extremity fracture. Isometric quadriceps strength and RTD were quantified using isometric dynamometry, and a timed step-down test was used to evaluate quadriceps performance. Independent predictor variables from the time of surgery were extracted from participants' medical records. Kinesiophobia was screened at the time of testing. Wilcoxon signed-rank tests and linear regression analyses were used to assess between-limb differences in quadriceps performance and to determine factors associated with quadriceps performance 12 months after surgery. RESULTS Significant between-limb differences in each measure of quadriceps performance were identified (peak torque involved: 1.37 [0.71] Nm × kg-1; uninvolved: 1.87 [0.74] Nm × kg-1; RTD involved: 4.16 [2.75] Nm × kg-1 × s-1; uninvolved: 6.10 [3.02] Nm × kg-1 × × -1; and single-leg step-downs involved: 12.6 [5.0]; uninvolved: 21.7 [14.8]). Female biological sex, external fixation, and kinesiophobia at 12 months were associated with reduced after-surgery quadriceps performance outcomes. CONCLUSION Quadriceps performance is impaired 12 months after surgical repair of a lower extremity fracture, particularly in female participants, in cases requiring external fixation, and in those with higher kinesiophobia 12 months after surgery. IMPACT Because long-term quadriceps weakness negatively impacts functional mobility, targeted strengthening should be emphasized after surgical repair of lower extremity fracture.
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Affiliation(s)
- Benjamin D Brightwell
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Joshua J Van Wyngaarden
- Army-Baylor University Doctoral Program in Physical Therapy, Department of Physical Therapy, Baylor University, San Antonio, Texas, USA
| | - Michael A Samaan
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Paul E Matuszewski
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Cale A Jacobs
- Mass General Brigham Sports Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, USA
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Hogan A, Danzer NM, Blaschke L, Grützner PA, Mandelka E, Trinler U, Vetter SY. Influence of quality of reduction using radiological criteria on kinematics and kinetics in ankle fractures with unstable syndesmotic injury. Clin Biomech (Bristol, Avon) 2023; 108:106054. [PMID: 37541033 DOI: 10.1016/j.clinbiomech.2023.106054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND In ankle fractures with syndesmotic injury, the anatomic reduction of the ankle mortise is crucial for preventing osteoarthritis. Yet, no studies have analysed the effect of surgical reduction after unstable ankle fractures on patients' active functional outcome. METHODS The Intraoperative 3D imaging data of patients surgically treated between 2012 and 2019 for ankle fracture with concomitant syndesmotic injury were reviewed. 58 patients were allocated to two groups depending on whether the criteria for radiologically optimal reduction were met (39 patients) or not (19 patients). Criteria for optimal reduction were composed of objectively measured and subjectively rated data. After undertaking the Olerud/Molander ankle score, a gait analysis and several active function tests using 3D motion capture were performed in order to evaluate kinetic and kinematic differences between both groups. FINDINGS Patients showed deficits of range of motion and balance parameters on the injured ankle, however, there were no significant differences between both groups. INTERPRETATION Although, the data did not show that radiological reduction criteria have a statistically significant effect on active functional outcome after a mean follow up time of 5.7 years, tendencies for a better outcome of patients that met the criteria could be seen. It also must be taken into consideration that results are limited by case number and allocation ratio, which made a sub-analysis of the separate reduction criteria unfeasible.
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Affiliation(s)
- Aidan Hogan
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | | | - Laura Blaschke
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | | | - Eric Mandelka
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Ursula Trinler
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Sven Y Vetter
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
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Fernández-Gorgojo M, Salas-Gómez D, Sánchez-Juan P, Laguna-Bercero E, Pérez-Núñez MI. Analysis of Dynamic Plantar Pressure and Influence of Clinical-Functional Measures on Their Performance in Subjects with Bimalleolar Ankle Fracture at 6 and 12 Months Post-Surgery. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23083975. [PMID: 37112316 PMCID: PMC10142754 DOI: 10.3390/s23083975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Abstract
Recovery after ankle fracture surgery can be slow and even present functional deficits in the long term, so it is essential to monitor the rehabilitation process objectively and detect which parameters are recovered earlier or later. The aim of this study was (1) to evaluate dynamic plantar pressure and functional status in patients with bimalleolar ankle fracture 6 and 12 months after surgery, and (2) to study their degree of correlation with previously collected clinical variables. Twenty-two subjects with bimalleolar ankle fractures and eleven healthy subjects were included in the study. Data collection was performed at 6 and 12 months after surgery and included clinical measurements (ankle dorsiflexion range of motion and bimalleolar/calf circumference), functional scales (AOFAS and OMAS), and dynamic plantar pressure analysis. The main results found in plantar pressure were a lower mean/peak plantar pressure, as well as a lower contact time at 6 and 12 months with respect to the healthy leg and control group and only the control group, respectively (effect size 0.63 ≤ d ≤ 0.97). Furthermore, in the ankle fracture group there is a moderate negative correlation (-0.435 ≤ r ≤ 0.674) between plantar pressures (average and peak) with bimalleolar and calf circumference. The AOFAS and OMAS scale scores increased at 12 months to 84.4 and 80.0 points, respectively. Despite the evident improvement one year after surgery, data collected using the pressure platform and functional scales suggest that recovery is not yet complete.
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Affiliation(s)
- Mario Fernández-Gorgojo
- Movement Analysis Laboratory, Escuelas Universitarias Gimbernat (EUG), Physiotherapy School Cantabria, University of Cantabria, 39300 Torrelavega, Spain
| | - Diana Salas-Gómez
- Movement Analysis Laboratory, Escuelas Universitarias Gimbernat (EUG), Physiotherapy School Cantabria, University of Cantabria, 39300 Torrelavega, Spain
- Correspondence:
| | - Pascual Sánchez-Juan
- Alzheimer’s Centre Reina Sofia-CIEN Foundation, 28031 Madrid, Spain
- Neurodegenerative Disease Network Biomedical Research Center (CIBERNED), 28029 Madrid, Spain
| | - Esther Laguna-Bercero
- Traumatology Service and Orthopedic Surgery, University Hospital “Marqués de Valdecilla” (UHMV), 39008 Santander, Spain
| | - María Isabel Pérez-Núñez
- Traumatology Service and Orthopedic Surgery, University Hospital “Marqués de Valdecilla” (UHMV), 39008 Santander, Spain
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Hoekstra H, Vinckier O, Staes F, Berckmans L, Coninx J, Matricali G, Wuite S, Vanstraelen E, Deschamps K. In Vivo Foot Segmental Motion and Coupling Analysis during Midterm Follow-Up after the Open Reduction Internal Fixation of Trimalleolar Fractures. J Clin Med 2023; 12:jcm12082772. [PMID: 37109109 PMCID: PMC10146606 DOI: 10.3390/jcm12082772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE Trimalleolar ankle fractures (TAFs) are common traumatic injuries. Studies have described postoperative clinical outcomes in relation to fracture morphology, but less is known about foot biomechanics, especially in patients treated for TAFs. The aim of this study was to analyze segmental foot mobility and joint coupling during the gait of patients after TAF treatment. METHODS Fifteen patients, surgically treated for TAFs, were recruited. The affected side was compared to their non-affected side, as well as to a healthy control subject. The Rizzoli foot model was used to quantify inter-segment joint angles and joint coupling. The stance phase was observed and divided into sub-phases. Patient-reported outcome measures were evaluated. RESULTS Patients treated for TAFs showed a reduced range of motion in the affected ankle during the loading response (3.8 ± 0.9) and pre-swing phase (12.7 ± 3.5) as compared to their non-affected sides (4.7 ± 1.1 and 16.1 ± 3.1) and the control subject. The dorsiflexion of the first metatarsophalangeal joint during the pre-swing phase was reduced (19.0 ± 6.5) when compared to the non-affected side (23.3 ± 8.7). The affected side's Chopart joint showed an increased range of motion during the mid-stance (1.3 ± 0.5 vs. 1.1 ± 0.6). Smaller joint coupling was observed on both the patient-affected and non-affected sides compared to the controls. CONCLUSION This study indicates that the Chopart joint compensates for changes in the ankle segment after TAF osteosynthesis. Furthermore, reduced joint-coupling was observed. However, the minimal case numbers and study power limited the effect size of this study. Nevertheless, these new insights could help to elucidate foot biomechanics in these patients, adjusting rehabilitation programs, thereby lowering the risk of postoperative long-term complications.
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Affiliation(s)
- Harm Hoekstra
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Development and Regeneration, KU Leuven-University of Leuven, 3000 Leuven, Belgium
| | - Olivier Vinckier
- Department of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Filip Staes
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - Lisa Berckmans
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - Jolien Coninx
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - Giovanni Matricali
- Department of Development and Regeneration, KU Leuven-University of Leuven, 3000 Leuven, Belgium
- Department of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Institute for Orthopaedic Research and Training, KU Leuven-University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Sander Wuite
- Department of Development and Regeneration, KU Leuven-University of Leuven, 3000 Leuven, Belgium
- Department of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Institute for Orthopaedic Research and Training, KU Leuven-University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Eline Vanstraelen
- Clinical Motion Analysis Laboratory, Campus Pellenberg, University Hospitals Leuven, Weligerveld 1, 3212 Lubbeek, Belgium
| | - Kevin Deschamps
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Tervuursevest 101, 3001 Leuven, Belgium
- Clinical Motion Analysis Laboratory, Campus Pellenberg, University Hospitals Leuven, Weligerveld 1, 3212 Lubbeek, Belgium
- Division of Podiatry, Institut D'Enseignement Supérieur Parnasse Deux-Alice, Haute Ecole Leonard de Vinci, Avenue e Mounier 84, 1200 Bruxelles, Belgium
- Department of Podiatry, Artevelde University College, Hoogpoort 15, 9000 Gent, Belgium
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Gait Analysis to Monitor Fracture Healing of the Lower Leg. Bioengineering (Basel) 2023; 10:bioengineering10020255. [PMID: 36829749 PMCID: PMC9952799 DOI: 10.3390/bioengineering10020255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Fracture healing is typically monitored by infrequent radiographs. Radiographs come at the cost of radiation exposure and reflect fracture healing with a time lag due to delayed fracture mineralization following increases in stiffness. Since union problems frequently occur after fractures, better and timelier methods to monitor the healing process are required. In this review, we provide an overview of the changes in gait parameters following lower leg fractures to investigate whether gait analysis can be used to monitor fracture healing. Studies assessing gait after lower leg fractures that were treated either surgically or conservatively were included. Spatiotemporal gait parameters, kinematics, kinetics, and pedography showed improvements in the gait pattern throughout the healing process of lower leg fractures. Especially gait speed and asymmetry measures have a high potential to monitor fracture healing. Pedographic measurements showed differences in gait between patients with and without union. No literature was available for other gait measures, but it is expected that further parameters reflect progress in bone healing. In conclusion, gait analysis seems to be a valuable tool for monitoring the healing process and predicting the occurrence of non-union of lower leg fractures.
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Deschamps K, Wouters J, Staes F, Vanstraelen E, Matricali GA, Wuite S, Hoekstra H. Evidence for symmetrically reduced foot mechanics and energetics in patients after trimalleolar fracture repair: A cross-sectional study. Gait Posture 2022; 97:13-20. [PMID: 35849967 DOI: 10.1016/j.gaitpost.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/20/2022] [Accepted: 07/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trimalleolar fractures osteosynthesis is associated with a suboptimal outcome. It is hypothesized that patients with trimalleolar fractures face different ankle joint kinetics at mid- and long-term causing compensations at the distal foot joints. RESEARCH QUESTION Do patients with a history of a trimalleolar fracture demonstrate different foot joint mechanics and energetics (1) between their affected side and their matched controls? (2) between their unaffected side and their matched controls? (3) between their affected side and their unaffected side? METHODS Fifteen patients who sustained a trimalleolar fracture and underwent osteosynthesis for both the lateral, medial and posterior malleolus were compared to a asymptomatic control group which was matched for sex, age and walking speed. Three-dimensional gait analysis was used to quantify kinetic parameters in the Ankle, Chopart, Lisfranc and first metatarsophalangeal joint through a multi-segment kinetic foot model. Statistical analysis was performed using a Univariate Analysis of Covariance and/or a paired t-test. RESULTS The peak internal ankle moment was significantly lower in patients when compared to the control group (p < 0.001). Mean peak power generation and total positive work were significantly lower for the Chopart joint when comparing the patients to the control group (p < 0.001). These results were observed for both the affected and unaffected side of the patients compared to the control group, showing symmetrical changes in the patient group. SIGNIFICANCE Despite adequate radiographic quality of reduction and the fact that all patients were treated according to a fixed postoperative protocol, this study indicates that patients with a history of a trimalleolar fracture demonstrate reduced foot joint kinetics. It is hypothesized that these findings originate from extrinsic and intrinsic foot muscle strength, stiffness and pain. Future research is needed to validate this hypothesis.
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Affiliation(s)
- Kevin Deschamps
- KU Leuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Campus Brugge, Spoorwegstraat 12, 8200 Brugge, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratorium, Campus Pellenberg, Weligerveld 1, 3212 Lubbeek, Belgium; Haute Ecole Leonard De Vinci, Institut D'Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Avenue E Mounier 84, 1200 Bruxelles, Belgium; Department of Podiatry, Artevelde University College, Hoogpoort 15, 9000 Gent, Belgium.
| | - Julia Wouters
- KU Leuven, Department of Rehabilitation Sciences, Campus Leuven, Tervuursevest 101, 3000 Leuven, Belgium.
| | - Filip Staes
- KU Leuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Campus Leuven, Tervuursevest 101, 3000 Leuven, Belgium.
| | - Eline Vanstraelen
- University Hospitals Leuven, Clinical Motion Analysis Laboratorium, Campus Pellenberg, Weligerveld 1, 3212 Lubbeek, Belgium.
| | - Giovanni A Matricali
- University Hospitals Leuven, Department of Orthopaedics, Herestraat 49, 3000 Leuven, Belgium; KU Leuven, Institute for Orthopaedic Research & Training, Herestraat 49, 3000 Leuven, Belgium; KU Leuven, Department of Development and Regeneration, Herestraat 49, 3000 Leuven, Belgium.
| | - Sander Wuite
- University Hospitals Leuven, Department of Orthopaedics, Herestraat 49, 3000 Leuven, Belgium; KU Leuven, Institute for Orthopaedic Research & Training, Herestraat 49, 3000 Leuven, Belgium; KU Leuven, Department of Development and Regeneration, Herestraat 49, 3000 Leuven, Belgium.
| | - Harm Hoekstra
- KU Leuven, Department of Development and Regeneration, Herestraat 49, 3000 Leuven, Belgium; University Hospitals Leuven, Department of Trauma Surgery, Herestraat 49, 3000 Leuven, Belgium.
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Zhu T, Wang Y, Tian F, Wang W, Zhong R, Zhai H, Wang S. Clinical assessments and gait analysis for patients with Trimalleolar fractures in the early postoperative period. BMC Musculoskelet Disord 2022; 23:663. [PMID: 35820837 PMCID: PMC9275242 DOI: 10.1186/s12891-022-05615-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background Trimalleolar fracture is a common ankle fracture with serious complications and costly healthcare problem. Most studies used clinical assessments to evaluate the functional status of the patients. Although clinical assessments are valid, they are static and subjective. Dynamic, objective and precise evaluations such as gait analysis are needed. Ankle biomechanics studies on gait in patients with trimalleolar fractures are still rare. This study aimed to investigate the clinical outcomes and gait biomechanics in patients with trimalleolar fractures in the early postoperative period and compared to healthy controls. Methods This was a cross-sectional study. 12 patients with trimalleolar fractures were recruited, and 12 healthy people served as controls. All patients underwent clinical assessments: Olerud and Molander ankle score (OMAS), ankle swelling and passive range of motion (ROM) of ankle, and completed gait biomechanical analysis when weight-bearing was allowed: temporal-spatial parameters, plantar pressure distributions, and surface electromyography (sEMG). The control group only performed gait test. Results Patients had poor outcomes of clinical assessments in the short-term. During gait analysis, patients presented compromised gait patterns: shorter step length, larger step width, slower walking speed and shorter single support compared to healthy controls (P < 0.001), and patients showed asymmetrical gait. Symmetry index of step width and walking speed were mainly correlated with the difference of ankle inversion ROM between two sides (R = -0.750, P = 0.005; R = -0.700, P = 0.011). During walking, patients showed abnormal dynamic plantar pressure features (mainly in the hindfoot and forefoot regions), and the IEMG (integrated electromyography) of tibial anterior muscle (TA) and peroneal longus muscle (PL) were larger than healthy controls (P = 0.002, 0.050). Conclusions Patients with trimalleolar fractures showed physical impairments of the ankle, and presented altered gait parameters compared to healthy subjects in the short-term. The ankle stability of patients declined, and deficits in TA and PL muscle ability might contribute to it. Restoring complete muscle functions and improving passive ankle ROM are significant to promote the recovery of a normal gait pattern.
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Affiliation(s)
- Ting Zhu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China
| | - Ya Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China.,Yangzhi Affiliated Rehabilitation Hospital of Tongji University (Shanghai Sunshine Rehabilitation Center), Building No.2, Guangxing Road No. 2209, Shanghai, 201619, China
| | - Fei Tian
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China.,Department of Rehabilitation Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Wenjin Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China
| | - Rongzhou Zhong
- Yangzhi Affiliated Rehabilitation Hospital of Tongji University (Shanghai Sunshine Rehabilitation Center), Building No.2, Guangxing Road No. 2209, Shanghai, 201619, China
| | - Hua Zhai
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China. .,Yangzhi Affiliated Rehabilitation Hospital of Tongji University (Shanghai Sunshine Rehabilitation Center), Building No.2, Guangxing Road No. 2209, Shanghai, 201619, China.
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China.
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11
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Chan BHT, Snowdon DA, Williams CM. The association between person and fracture characteristics with patient reported outcome after ankle fractures in adults: A systematic review. Injury 2022; 53:2340-2365. [PMID: 35197205 DOI: 10.1016/j.injury.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of ankle fractures is increasing and the clinical outcome is highly variable. QUESTION What person and fracture characteristics are associated with patient reported outcomes after surgically or conservatively managed ankle fractures in adults? DATA SOURCES Medline, EMBASE, and Allied and Complimentary Health Medical Database (AMED) databases were searched from the earliest available date until 16th July 2020. STUDY SELECTION Prognostic factors studies recruiting adults of age 18 years or older with a radiologically confirmed ankle fracture, and evaluating function, symptoms and quality of life by patient reported outcome measures, were included. STUDY APPRAISAL/SYNTHESIS METHODS Risk of bias of individual studies was assessed by the Quality in Prognostic Factors Studies tool. Correlation coefficients were calculated and data were analysed using narrative synthesis. RESULTS Fifty-one phase 1 explanatory studies with 6177 participants met the inclusion criteria. Thirty-one studies were rated as high risk of bias using the Quality in Prognostic Factors Studies tool. There was low quality evidence that age, body mass index, American Society of Anesthesiologists classification and pre-injury mobility were associated with function, and low to moderate quality evidence that age, smoking and American Society of Anesthesiologists classification were associated with quality of life. No person characteristics were associated with symptoms and no fracture characteristics were associated with any outcomes. CONCLUSION There was low to moderate quality evidence that person characteristics may be associated with patient reported function and quality of life following ankle fracture. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020184830.
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Affiliation(s)
- Billy H T Chan
- Department of Physiotherapy, Monash University, Frankston, VIC 3199, Australia.
| | - David A Snowdon
- Department of Allied Health, Peninsula Health, Frankston, VIC 3199, Australia; Peninsula Clinical School, Monash University, Frankston, VIC 3199, Australia.
| | - Cylie M Williams
- Department of Physiotherapy, Monash University, Frankston, VIC 3199, Australia; Department of Allied Health, Peninsula Health, Frankston, VIC 3199, Australia.
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12
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Fernández-Gorgojo M, Salas-Gómez D, Sánchez-Juan P, Barbado D, Laguna-Bercero E, Pérez-Núñez MI. Clinical-Functional Evaluation and Test-Retest Reliability of the G-WALK Sensor in Subjects with Bimalleolar Ankle Fractures 6 Months after Surgery. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22083050. [PMID: 35459036 PMCID: PMC9032166 DOI: 10.3390/s22083050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 05/14/2023]
Abstract
Ankle fractures can cause significant functional impairment in the short and long term. In recent years, gait analysis using inertial sensors has gained special relevance as a reliable measurement system. This study aimed to evaluate the differences in spatiotemporal gait parameters and clinical−functional measurements in patients with bimalleolar ankle fracture and healthy subjects, to study the correlation between the different variables, and to analyze the test−retest reliability of a single inertial sensor in our study population. Twenty-two subjects with bimalleolar ankle fracture six months after surgery and eleven healthy subjects were included in the study. Spatiotemporal parameters were analyzed with the G-WALK sensor. Functional scales and clinical measures were collected beforehand. In the ankle fracture group, the main differences were obtained in bilateral parameters (effect size: 0.61 ≤ d ≤ 0.80). Between-group differences were found in cadence, speed, stride length, and stride time (effect size: 1.61 ≤ d ≤ 1.82). Correlation was moderate (0.436 < r < 0.554) between spatiotemporal parameters and clinical−functional measures, explaining up to 46% of gait performance. Test−retest reliability scores were high to excellent (0.84 ≤ ICC ≤ 0.98), with the worst results in the gait phases. Our study population presents evident clinical−functional impairments 6 months after surgery. The G-WALK can be considered a reliable tool for clinical use in this population.
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Affiliation(s)
- Mario Fernández-Gorgojo
- Escuelas Universitarias Gimbernat (EUG), Physiotherapy School Cantabria, Movement Analysis Laboratory, University of Cantabria, 39005 Torrelavega, Spain; (M.F.-G.); (P.S.-J.); (E.L.-B.); (M.I.P.-N.)
- International Doctoral School, Rey Juan Carlos University (URJC), 28032 Madrid, Spain
| | - Diana Salas-Gómez
- Escuelas Universitarias Gimbernat (EUG), Physiotherapy School Cantabria, Movement Analysis Laboratory, University of Cantabria, 39005 Torrelavega, Spain; (M.F.-G.); (P.S.-J.); (E.L.-B.); (M.I.P.-N.)
- Correspondence:
| | - Pascual Sánchez-Juan
- Escuelas Universitarias Gimbernat (EUG), Physiotherapy School Cantabria, Movement Analysis Laboratory, University of Cantabria, 39005 Torrelavega, Spain; (M.F.-G.); (P.S.-J.); (E.L.-B.); (M.I.P.-N.)
- Alzheimer’s Centre Reina Sofia-CIEN Foundation, 28031 Madrid, Spain
| | - David Barbado
- Sports Research Centre, Department of Sport Science, Miguel Hernández University of Elche, 03202 Elche, Spain;
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03550 Alicante, Spain
| | - Esther Laguna-Bercero
- Escuelas Universitarias Gimbernat (EUG), Physiotherapy School Cantabria, Movement Analysis Laboratory, University of Cantabria, 39005 Torrelavega, Spain; (M.F.-G.); (P.S.-J.); (E.L.-B.); (M.I.P.-N.)
- Traumatology Service and Orthopedic Surgery, University Hospital “Marqués de Valdecilla” (UHMV), 39008 Santander, Spain
| | - María Isabel Pérez-Núñez
- Escuelas Universitarias Gimbernat (EUG), Physiotherapy School Cantabria, Movement Analysis Laboratory, University of Cantabria, 39005 Torrelavega, Spain; (M.F.-G.); (P.S.-J.); (E.L.-B.); (M.I.P.-N.)
- Traumatology Service and Orthopedic Surgery, University Hospital “Marqués de Valdecilla” (UHMV), 39008 Santander, Spain
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13
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Rosenblum U, Melzer I, Zeilig G, Plotnik M. Muscle activation profile is modulated by unexpected balance loss in walking. Gait Posture 2022; 93:64-72. [PMID: 35091185 DOI: 10.1016/j.gaitpost.2022.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/30/2021] [Accepted: 01/16/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND During an unexpected loss of balance, avoiding a fall requires people to readjust their footing rapidly and effectively. A deeper understanding of muscle activation patterns in response to unexpected balance loss will provide insights into the mechanisms of balance recovery responses. This could have implications for treatment of people with balance deficits. RESEARCH QUESTION Explore the differences in balance recovery responses to perturbations in different phases of the gait cycle (single-support vs. double-support) in terms of biomechanical behavior (i.e., stepping and dynamic stability characteristics) and lower-limb muscle activation patterns. METHODS Muscle activation patterns of the ankle and knee muscles and muscle fiber type recruitment resulting from unannounced, mediolateral (i.e., right/left) horizontal-surface perturbations during walking was investigated in twenty healthy adults (27.00 ± 2.79 years, ten females). Surface electromyography (sEMG) total spectral power for specific frequency bands (40-60 Hz, 60-150 Hz, 150-250 Hz, 250-400 Hz and 400-1000 Hz), from tibialis anterior (TA) and vastus lateralis (VL) muscles were analyzed. Three mixed-effects models assessed behavioral and lower-limb muscle activation patterns resulting from perturbations in the gait cycle's single- and double-support phases. Statistical significance was set a priori at p < 0.05. RESULTS Compared to non-perturbed walking, we found a significant increase in the total spectral power of lower-extremity muscles during the first three seconds after perturbation. During the double-support phase of gait, we found a different muscle fiber type recruitment pattern between VL and TA muscles. However, there were no significant differences between VL and TA muscles for perturbations implemented in single-support phases. SIGNIFICANCE Our findings support the notion that muscle operating frequency is modulated in real-time to fit functional goal requirements, such as a rapid change of footing in response to unexpected loss of balance in single and double-support phases of gait.
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Affiliation(s)
- Uri Rosenblum
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel; Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Itshak Melzer
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Sheba Medical Center, Tel HaShomer, Israel; Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Tel Aviv University, Israel; School of Health Professions, Ono Academic College, Kiryat Ono, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel; Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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14
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Gait Alterations in Adults after Ankle Fracture: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12010199. [PMID: 35054366 PMCID: PMC8774579 DOI: 10.3390/diagnostics12010199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/24/2021] [Accepted: 12/26/2021] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait cycle. Nevertheless, a common pattern of kinematic alterations has still not been defined. To this end, we analyzed the literature on instrumental gait assessment after ankle fracture, and its correlation with evaluator-based and patient-reported outcome measures. (2) Methods: We conducted a systematic search, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, of articles published from January 2000 to June 2021 in PubMed, Embase and PEDro on instrumental gait assessment after ankle fracture. (3) Results: Several changes in gait occur after ankle fracture, including a reduction in step length, swing time, single support time, stride length, cadence, speed and an earlier foot-off time in the affected side. Additionally, trunk movement symmetry (especially vertical) is significantly reduced after ankle fracture. The instrumental assessments correlate with different clinical outcome measures. (4) Conclusions: Instrumental gait assessment can provide an objective characterization of the gait alterations after ankle fracture. Such assessment is important not only in clinical practice to assess patients’ performance but also in clinical research as a reference point to evaluate existing or new rehabilitative interventions.
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Böpple JC, Tanner M, Campos S, Fischer C, Müller S, Wolf SI, Doll J. Short-term results of gait analysis with the Heidelberg foot measurement method and functional outcome after operative treatment of ankle fractures. J Foot Ankle Res 2022; 15:2. [PMID: 34998420 PMCID: PMC8742407 DOI: 10.1186/s13047-021-00505-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background Ankle fractures are common fractures in trauma surgery. Several studies have compared gait patterns between affected patients and control groups. However, no one used the Heidelberg Foot Measurement Method in combination with statistical parametric mapping of the entire gait cycle in this patient cohort. We sought to identify possible mobility deficits in the tibio-talar joint and medial arch in patients after ankle fractures as a sign of stiffness and pain that could result in a pathological gait pattern. We focused on the tibio-talar flexion as it is the main movement in the tibio-talar joint. Moreover, we examined the healing progress over time. Methods Fourteen patients with isolated ankle fractures were included prospectively. A gait analysis using the Heidelberg Foot Measurement Method was performed 9 and 26 weeks after surgery to analyse the tibio-talar dorsal flexion, the foot tibia dorsal flexion, the subtalar inversion and the medial arch as well as the cadence, the walking speed and the ground reaction force. The American Orthopedic Foot & Ankle Society ankle hindfoot score was used to obtain clinical data. Results were compared to those from 20 healthy participants. Furthermore, correlations between the American Orthopedic Foot & Ankle Society hindfoot score and the results of the gait analysis were evaluated. Results Statistical parametric mapping showed significant differences for the Foot Tibia Dorsal Flexion for patients after 9 weeks (53–75%: p = 0.001) and patients after 26 weeks (58–70%: p = 0.011) compared to healthy participants, respectively. Furthermore, significant differences regarding the tibio-talar dorsal flexion for patients 9 weeks after surgery (15–40%: p < 0.001; 56,5–70%: p = 0.007; 82–88%: p = 0.033; 97–98,5%: p = 0.048) as well as patients after 26 weeks (62,5–65%: p = 0.049) compared to healthy participants, respectively. There were no significant differences looking at the medial arch and the subtalar inversion. Moreover, significant differences regarding the ground reaction force were found for patients after 9 weeks (0–17%: p < 0.001; 21–37%: p < 0.001; 41–54%: p < 0.001; 60–64%: p = 0.013) as well as patients after 26 weeks (0–1,5%: p = 0.046; 5–15%: p < 0.001; 27–33%: p = 0.001; 45–49%: p = 0.005; 57–59%: p = 0.049) compared to healthy participants, respectively. In total, the range of motion in the tibio-talar joint and the medial arch was reduced in affected patients compared to healthy participants. Patients showed significant increase of the range of motion between 9 and 26 weeks. Conclusions This study shows, that patients affected by ankle fractures show limited mobility in the tibio-talar joint and the medial arch when compared to healthy participants. Even though the limitation of motion remains at least over a period of 26 weeks, a significant increase can be recognized over time. Furthermore, if we look at the absolute values, the patients’ values tend to get closer to those of the control group. Trial registration This study is registered at the German Clinical Trials Register (DRKS00023379).
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Affiliation(s)
- Jessica C Böpple
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Michael Tanner
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Sarah Campos
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Sebastian Müller
- ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany
| | - Sebastian I Wolf
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Julian Doll
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Chen H, Li Z, Yang D, Wang P, Niu J, He X, Wu G. Clinical study of intramedullary nailing fixation for the treatment of Danis-Weber B in lateral malleolus fracture. J Int Med Res 2021; 49:3000605211047371. [PMID: 34713740 PMCID: PMC8645306 DOI: 10.1177/03000605211047371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the clinical effects between anatomical locking plates and interlocking intramedullary nails in patients with Danis-Weber B lateral malleolus fractures. METHODS This retrospective study enrolled patients with Danis-Weber B fractures of the lateral malleolus. All the operations were completed by the same group of surgeons. The reduction effect, operation time, intraoperative blood loss, hospital stay, fracture healing time and ankle functional outcomes (Olerud-Molander Ankle Score [OMAS]) were compared. Postoperative complications, including incision infections, fixation discomfort and internal fixation loosening, were also compared. RESULTS This study enrolled 73 patients that were treated with either an anatomical locking plate (locking plate group; n = 37) or an interlocking intramedullary nail (intramedullary nail group; n = 36). There was no significant difference between the two groups in terms of reduction effect, hospital stay and OMAS. The intramedullary nail group had significantly lower operation time, intraoperative blood loss and fracture healing time compared with the locking plate group. Postoperative complications in the intramedullary nail group were significantly lower compared with the locking plate group. CONCLUSION Using intramedullary nails resulted in more satisfactory functional outcomes compared with using locking plates in patients with Danis-Weber B fractures of the lateral malleolus.
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Affiliation(s)
- Hongfeng Chen
- Department of Foot and Ankle Surgery, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Zhen Li
- Department of Foot and Ankle Surgery, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Dongsong Yang
- Department of Orthopaedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Pengru Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Junke Niu
- Department of Orthopaedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Xishun He
- Department of Orthopaedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
| | - Guangliang Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan Province, China
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Szulc P. Impact of Bone Fracture on Muscle Strength and Physical Performance-Narrative Review. Curr Osteoporos Rep 2020; 18:633-645. [PMID: 33030682 DOI: 10.1007/s11914-020-00623-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Low muscle strength and poor physical performance are associated with high risk of fracture. Many studies assessed clinical and functional outcomes of fractures. Fewer studies analyzed the impact of fractures on muscle strength and physical performance. RECENT FINDINGS Vertebral fractures (especially multiple and severe ones) are associated with back pain, back-related disability, lower grip strength, lower strength of lower limbs, lower gait speed, and poor balance. Patients with hip fracture have slower gait and lower quadriceps strength. Non-vertebral fractures were associated with lower strength of the muscles adjacent to the fracture site (e.g., grip strength in the case of distal radius fracture, knee extensors in the case of patellar fracture) and poor physical function dependent on the muscles adjacent to the fracture site (e.g., limited range of motion of the shoulder in the case of humerus fracture, gait disturbances in the case of the ankle fracture). Individuals with a fracture experience a substantial deterioration of muscle strength and physical performance which exceeds that related to aging and is focused on the period close to the fracture occurrence. After fracture, muscle strength increased and physical performance improved. The rate of normalization depended partly on the therapeutic approach and on the rehabilitation program. A subgroup of patients, mainly the elderly, never returns to the pre-fracture level of physical performance. The permanent decline of physical function after fracture may be related to the limitation of movements due to pain, low physical activity, poor health before the fracture, and reduced efficacy of retraining after immobilization.
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Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
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Electronically augmented gait abnormality assessment following lower extremity trauma. OTA Int 2019; 2:e032. [PMID: 33937664 PMCID: PMC7997086 DOI: 10.1097/oi9.0000000000000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 12/26/2018] [Indexed: 11/26/2022]
Abstract
Background: Objective evaluation of patient outcomes has become an essential component of patient management. Along with patient-reported outcomes, performance-based measures (PBMs) such as gait analysis are an important part of this evaluation. The purpose of this study was to evaluate the validity of utilizing a wearable inertial measurement unit (IMU) in an outpatient clinic setting to assess its ability to provide clinically relevant data in patients with altered gait resulting from lower extremity trauma. Methods: Five orthopaedic trauma patients with varying degrees of gait pathologies were compared to 5 healthy control subjects. Kinematic data were simultaneously recorded by the IMU and a gold standard Vicon video motion analysis system (Vicon Motion Systems Ltd, Oxford, UK) during a modified 10-m walk test. Raw data captured by the IMU were directly compared to Vicon data. Additionally, 5 objective gait parameters were compared for controls and the 5 trauma patients. Results: The IMU data streams strongly correlated with Vicon data for measured variables used in the subsequent gait analysis: vertical acceleration, vertical displacement, pitch angular velocity, and roll angular velocity (Pearson r-value > 0.9 for all correlations). Quantitative kinematic data in post-trauma patients significantly differed from control data and correlated with observed gait pathology. Conclusions: When compared to the gold standard motion capture reference system (Vicon), an IMU can reliably and accurately measure clinically relevant gait parameters and differentiate between normal and pathologic gait patterns. This technology is easily integrated into clinical settings, requires minimal time, and represents a performance-based method for quantifiably assessing gait outcomes. Level of Evidence: Diagnostic Level 1.
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