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Brand A, Alexander N, Bauer L, Böhm H, Stief F, van Drongelen S, Wolf SI, Trinler U. [An update on clinical gait analysis : Current developments and applications]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:494-502. [PMID: 38847874 DOI: 10.1007/s00132-024-04516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/29/2024]
Abstract
The objective acquisition and assessment of joint movements and loads using instrumented gait analysis has become an established tool in clinical diagnostics. In particular, marker-based 3D gait analyses make use of an increasingly comprehensive database for the assessment of orthopaedic or neurological questions. Based on this data and medical-scientific experience, increasingly reliable approaches and evaluation strategies are emerging, which also draw on methods from artificial intelligence and musculoskeletal modelling. This article focusses on marker-based gait analyses of the lower extremity (hip, knee, foot) and how these can be used in a clinically relevant way using current methods, e.g. for determining indications or optimization of surgical planning. Finally, current developments and applications by using alternative methods from sensor technology and optical motion capture will be briefly discussed.
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Affiliation(s)
- Andreas Brand
- Institut für Biomechanik, BG Unfallklinik Murnau, Murnau, Deutschland
- Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
| | - Nathalie Alexander
- Labor für Bewegungsanalyse, Ostschweizer Kinderspital, St. Gallen, Schweiz
| | - Leandra Bauer
- Experimentelle Orthopädie, Universitätsklinikum Jena, Campus Eisenberg, Waldkliniken Eisenberg, Eisenberg, Deutschland
| | - Harald Böhm
- Orthopädische Kinderklinik, Behandlungszentrum Aschau gGmbH, Aschau im Chiemgau, Deutschland
- Fakultät Ingenieurwissenschaften und Gesundheit, Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Hildesheim, Deutschland
| | - Felix Stief
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main, Deutschland
- BG Service- und Rehabilitationszentrum, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Stefan van Drongelen
- Dr. Rolf M. Schwiete Forschungsbereich für Arthrose, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Sebastian I Wolf
- Klinik für Orthopädie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ursula Trinler
- Andreas Wentzensen Forschungsinstitut, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
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Attenasio A, Heiman E, Hong IS, Bhalla AP, Jankowski JM, Yoon RS, Liporace FA, Dziadosz D. Postoperative wound complications in extensile lateral approach versus sinus tarsi approach for calcaneal fractures: Are we improving? Updated meta-analysis of recent literature. Injury 2024; 55:111560. [PMID: 38729077 DOI: 10.1016/j.injury.2024.111560] [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: 02/22/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION To analyze recent literature comparing clinical outcomes of displaced intra-articular calcaneal fractures (DIACF) treated with open reduction and internal fixation using the extensile lateral approach (ELA) vs the minimally invasive sinus tarsi approach (STA), with a focus on wound complications. MATERIALS AND METHODS A comprehensive literature search was conducted utilizing PubMed, EMBASE, and Cochrane Library databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 2013 and 2022, level of evidence (LOE) I-III, head-to-head comparative studies reporting on clinical outcomes after DIACFs treated with ORIF using ELA versus STA, and literature with full-text written in English were included. Data collection included: publication year, study design, number of surgeons, number of participants, demographic data (mean age at time of surgery, percent male, body mass index, medical co-morbidities), preoperative data (mechanism of injury, Sanders classification, time from injury to surgical fixation), intraoperative data, and postoperative clinical and radiographic outcomes (Böhler angle, angle of Gissane, calcaneal height/length/width). RESULTS A total of 21 articles (4 randomized control trials, 17 cohort studies) comprising of 2086 patients with calcaneal fractures, treated with either ELA (n = 1129) or STA (n = 957) met inclusion criteria. The risk of postoperative wound-related complications (RR 2.82, 95 % CI: 2.00-3.98, I2=27 %) and the risk of reoperation (RR 1.85, 95 % CI: 0.69-5.00, I2=67 %) was higher in ELA patients comparted to STA patients. However, the increased risk of postoperative wound-related complications with an ELA vs. STA was shown to be trending downward in recent publications. The ELA group also experienced longer time to surgery, extended operative times, and prolonged hospital stays when compared to the STA group. Radiographic measurements at final follow-up, including Böhler angle, angle of Gissane, as well as calcaneal height, length, and width, showed no statistically significant differences between the two groups. CONCLUSION Surgical treatment of calcaneal fractures utilizing the ELA continues to have an increased rate of complications and reoperation when compared to the less invasive STA, yet recent trends in the literature show that this rate is decreasing. Operative treatment of calcaneal fractures via either an ELA or STA can both achieve comparable postoperative radiographic outcomes. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Andrea Attenasio
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Erick Heiman
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Ian S Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Aditya Paul Bhalla
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Jaclyn M Jankowski
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Richard S Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA.
| | - Frank A Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Daniel Dziadosz
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
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Development of the center of pressure velocity in the healing process after intra-articular calcaneus fractures. Gait Posture 2022; 95:135-140. [PMID: 35489225 DOI: 10.1016/j.gaitpost.2022.04.015] [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: 01/12/2022] [Revised: 03/15/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Calcaneal fractures are among the most common foot injuries and sometimes develop manifold post-surgical complications. Restricted foot movement is one of the main functional limitations which often persists during long-term rehabilitation. Therefore, it is important to quantitatively monitor the biomechanical foot mobility after calcaneal fracture from an early stage in order to achieve an optimal therapeutic treatment. RESEARCH QUESTION Evaluation of the Center of Pressure velocity (vCOP) in patients after intrarticular calcaneal fractures during the healing progress from three to 24 months after surgery. METHODS A total of 20 patients with unilateral calcaneal fracture were investigated by means of pedobarography and marker-based gait analysis at three, six, 12 and 24 months after surgery. Data for vCOP [m/s], maximum external dorsal extension moments during stance (DEmomentstance) and tibiotalar range of motion during mid stance (MS) and terminal stance (TS) were obtained. Functional evaluation was performed using clinical examination (e.g. calf circumference measurements) and patient-reported outcome measures (SF-36). RESULTS When compared to the healthy side, vCOP of the injured side showed a significant reduction during MS (3 months: 48%, p < 0.001; 6 months: 13%; p = 0.040) and an significant increase during TS (3 months: 110%, p < 0.001; 6 months: 43%, p < 0.001; 12 months: 17%, p = 0.012). DEmomentstance of the fractured foot, showed a significant increase of 80% (p < 0.001) from three to 24 months after surgery, which correlated with vCOP at three and six months after surgery (p < 0.05; vCOP MS: 3 months: r = 0.876, 6 months: r = 0.685; vCOP TS: 3 months: r = -0.554, 6 months r = -0.626). SIGNIFICANCE vCOP might serve as an indicator for foot mobility and function during the early healing phase after calcaneal fractures. As vCOP can be obtained by pedobarography it is more readily accessible an less costly compared to foot function obtained by marker based gait analysis.
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Brand A, Kröger I, Klöpfer-Krämer I, Wackerle H, Müßig JA, Dietrich A, Böttger M, Gaul L, Gabel J, Augat P. Recovery of the medial gastrocnemius muscle after calcaneus fracture differs between contractile and elastic components. Clin Biomech (Bristol, Avon) 2022; 96:105664. [PMID: 35569257 DOI: 10.1016/j.clinbiomech.2022.105664] [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: 06/21/2021] [Revised: 03/22/2022] [Accepted: 05/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Calcaneal fractures result in severe functional impairments and walking restrictions. Postoperative evaluation mainly focusses on the restoration of calcaneal anatomy while ankle plantar flexor insufficiency remains largely neglected. This study aims to investigate biomechanical and morphologic adaptions of elastic and contractile components of the gastrocnemius medialis after unilateral calcaneal fracture. METHODS 20 Patients (BMI: 27.6 ± 3.1 kgm-2, Age: 50 ± 12 years) were measured using gait analysis and portable ultrasound over a follow-up of three, six and twelve months after surgery. Data comparison was performed using 20 matched healthy controls (BMI: 26.2 ± 2.9 kgm-2, Age: 48 ± 11 years). Static and dynamic behavior of the gastrocnemius muscle tendon unit, muscle fascicle and the serial-elastic element as well ankle joint kinematics and kinetics were analyzed. FINDINGS Within patients, a significant (p < 0.05) increase in fascicle length (by 67%) during single support and a decrease of serial elastic element shortening (by 20%) during push off was found between three and twelve months follow-up comparisons. Patients showed differences for fascicle lengthening and pennation angle increase during single support after three and six months compared to healthy controls. A smaller shortening of the serial-elastic element (by 29%) and muscle-tendon unit (by 16%) persisted even for the twelve month comparisons. INTERPRETATION Patients with calcaneal fracture showed an incomplete restoration of the medial gastrocnemius dynamic morphological behavior. While muscle fascicle contraction almost recovered, the serial elastic component still showed restrictions regarding its shortening behavior. Limited foot mobility and plantarflexor strength as well as lowered responsiveness of elastic tissues to mechanical loading are regarded as key mechanisms.
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Affiliation(s)
- Andreas Brand
- Institute for Biomechanics, BG Klinikum Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria.
| | - Inga Kröger
- Institute for Biomechanics, BG Klinikum Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Isabella Klöpfer-Krämer
- Institute for Biomechanics, BG Klinikum Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Hannes Wackerle
- Institute for Biomechanics, BG Klinikum Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Janina Anna Müßig
- Institute for Biomechanics, BG Klinikum Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Andrea Dietrich
- Department of Foot and Ankle Surgery, BG Klinikum Murnau, Murnau, Germany
| | - Moritz Böttger
- Department of Foot and Ankle Surgery, BG Klinikum Murnau, Murnau, Germany
| | - Leander Gaul
- Department of Foot and Ankle Surgery, BG Klinikum Murnau, Murnau, Germany
| | - Johannes Gabel
- Department of Foot and Ankle Surgery, BG Klinikum Murnau, Murnau, Germany
| | - Peter Augat
- Institute for Biomechanics, BG Klinikum Murnau, Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
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Zhang H, Sun F, Li Y. Application of Smart Healthcare in Comparative Analysis of Effect of Early External Fixator and Plate Internal Fixation Treatment on Postoperative Complications and Lower Limb Function Recovery of Patients With Unstable Pelvic Fracture. Front Public Health 2022; 10:887123. [PMID: 35570973 PMCID: PMC9099004 DOI: 10.3389/fpubh.2022.887123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo comparatively analyze the effect of early external fixator and plate internal fixation treatment on postoperative complications and lower limb function recovery of patients with unstable pelvic fracture based on smart healthcare.MethodsThe clinical data of 98 patients with unstable pelvic fractures treated in our hospital from August 2018 to August 2021 were collected for retrospective analysis, and the patients were split into group A (plate internal fixation, n = 49) and group B (early external fixator treatment, n = 49) according to the surgical modalities. The time of operation, intraoperative blood loss, postoperative complications, etc. were compared between the two groups.ResultsBetween the two groups, group B had significantly better clinical indicators (P < 0.001), a greatly higher good rate of fracture reduction and postoperative Harris score (P < 0.05), and obviously lower VAS score and total incidence rate of postoperative complications (P < 0.05).ConclusionThrough the analysis based on smart healthcare, it is found that compared with plate internal fixation treatment, early external fixator treatment presents a better effect in treating patients with unstable pelvic fracture, because it is a reliable method to accelerate fracture healing, reduce postoperative complications, and improve lower limb function.
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Affiliation(s)
- Hongwei Zhang
- Department of Emergency, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Fang Sun
- Plastic Burn Beauty Center, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Yao Li
- Department of Orthopeadic Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
- *Correspondence: Yao Li
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He ZX, Lu ZH, Ou J, Wu ZL. The role of bone grafts in displaced intra-articular calcaneal fractures: A prospective study protocol. Medicine (Baltimore) 2020; 99:e23740. [PMID: 33350756 PMCID: PMC7769338 DOI: 10.1097/md.0000000000023740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: Whether the bone graft is needed in treating the displaced intra-articular calcaneal fractures (DIACFs) is still controversial. Therefore, in our study, we will explore the results of 2 approaches for the DIACFs surgical treatment. METHODS: The present report follows the Consolidated Standards of Reporting Trials (CONSORT) guidelines. All patients will be assigned randomly into 2 different groups through tossing the coins. Three experienced surgeons are assigned randomly to each group to implement the surgeries utilizing any of the surgical approach. Assignments are concealed in a sealed opaque envelope. Patients who meet the following conditions will be included in this experiment: (1).. DIACFs (greater than 2 mm) involve Sanders Type IIC, Type IIB as well as some Type III; and (2).. surgical treatment can be implemented within 7 days after injury. Some patients with obvious swelling can wait for 2 weeks before operation; (3).. patients with closed fracture and; (4).. unilateral fracture. In the 2 groups, the patients will follow the standard postoperative protocols. Patients are asked to finish 2 questionnaires, namely, American Orthopaedic Foot and Ankle Society score and short form 36. The ranges of motion of the ankle and the subtalar joint will be also measured. Postoperative complications such as deep infection, wound infection, and wound edge necrosis, the injury of sural nerve, and hematoma are recorded. RESULTS: Our study can provide significant information on the necessity of bone graft in DIACFs internal fixation treatment. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6246).
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Affiliation(s)
| | - Zheng-hao Lu
- Department of Spine Surgery, Affifiliated Nanhua Hospital of University of South China, Hengyang, Hunan, China
| | - Jun Ou
- Department of Spine Surgery, Affifiliated Nanhua Hospital of University of South China, Hengyang, Hunan, China
| | - Zhi-liang Wu
- Department of Spine Surgery, Affifiliated Nanhua Hospital of University of South China, Hengyang, Hunan, China
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Abstract
Displaced intra-articular calcaneal fractures are among the most difficult articular fractures to treat, with a high rate of potential complications. Is important to restore calcaneus posterior facet anatomy as well as calcaneus width, length, and height. The extensile lateral approach provides excellent fracture visualization and allows reduction of the displaced fracture fragments, but high complication rate has been described with this approach, so many studies favor the sinus tarsi approach. Recent evidence favoring sinus tarsi rather than the extensile lateral approach has shifted opinion toward this less invasive approach, which can be considered the new gold standard.
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Affiliation(s)
- Gabriel Khazen
- Hospital de Clinicas Caracas, Av Panteón, San Bernardino, Caracas 01050, Venezuela.
| | - Cesar Khazen Rassi
- Hospital de Clinicas Caracas, Av Panteón, San Bernardino, Caracas 01050, Venezuela
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Gait analysis - Available platforms for outcome assessment. Injury 2020; 51 Suppl 2:S90-S96. [PMID: 31767371 DOI: 10.1016/j.injury.2019.11.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/24/2019] [Accepted: 11/09/2019] [Indexed: 02/02/2023]
Abstract
Movement or gait analysis has become a viable assessment tool not only used in sports science or basic biomechanical research, but has also expanded to be a very valuable instrument in clinical diagnostics, monitoring functional recovery and musculoskeletal rehabilitation. In this context, this method has long been an integral part solely in neurological disorders such as cerebral palsy. However, in the meantime the benefits have also become apparent in other medical areas, such as foot surgery, orthopaedic technology, or in patients after lower limb amputation. These procedures proved to better understand, objectify and quantify the individual causes of gait and movement disorders in order to optimize patient-specific therapy. Currently we are able to rely on a multitude of available measurement systems. These can either be used in everyday life for simple monitoring of one's own activity or to complement therapeutic approaches in the clinical and scientific environment. The following review highlights the various fields of movement analysis, including markerless motion capture, marker-based analysis, pedobarography and wearable sensors. Each of these areas presents its own field of application and potential usage as well as the advantages and disadvantages arising in this context. The following article will give an overview of the type of measurement technology used, the respective fields of application, and the selected parameters and their interpretation possibilities for each of the areas mentioned.
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