1
|
Ninomiya AF, Bertolucci V, Kaneko LO, Nonose N, Abreu LDL, Harfuch GR, dos Reis IGM, Scariot PPM, Messias LHD. Comparison of Radiographic Outcomes Assessed via the Radiographic Union Scale for Tibial Fractures and Alkaline Phosphatase Levels during the Tibial Healing Process: A Series of Case Reports. BIOLOGY 2024; 13:407. [PMID: 38927287 PMCID: PMC11200413 DOI: 10.3390/biology13060407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND/OBJECTIVES Tibial diaphysis fractures are common injuries resulting from high-to-low-energy traumas in patients of all age groups, but few reports currently provide complementary parameters for the assessment of bone healing processes in the postoperative period. Serum alkaline phosphatase (ALP) and the scores from the Radiographic Union Scale for Tibial Fractures (RUST) can promote new horizons in this context. Therefore, the aim of this study was to assess the behavior of ALP and RUST through within-subject comparisons from immediately post-surgery to 49 days after tibial diaphysis fracture repair. METHODS This article included four case studies where patients underwent the same procedures. Adults of both sexes aged 18 to 60 years with tibial fractures requiring surgery were included. After surgical intervention (T1), the patients were followed for 49 days after surgery, returning for follow-up appointments on the 21st (T2) and 49th (T3) days. At the follow-up appointments, new X-ray images were obtained, and blood samples were collected for ALP measurement. RESULTS Serum ALP levels increased by T2 following tibial reamed intramedullary nailing surgery. While this increase persisted into T3 for two patients, a decline was observed during the same period for the other two patients. Both events are indicative of the bone consolidation process, and RUST scores at the T3 corroborate this perspective for all patients included in this study. Considering that delta ALP (T3-T1 value) was lower in patients who exhibited the highest RUST score, we suggest that a synchronized analysis between ALP and RUST allows medics to diagnose bone consolidation. CONCLUSIONS Therefore, it can be concluded that the analysis of ALP alongside RUST may be complementary for evaluating bone consolidation following tibial reamed intramedullary nailing surgery, but future studies are needed to confirm this assertion.
Collapse
Affiliation(s)
- André Felipe Ninomiya
- Centre of Orthopedics Research, São Francisco University Hospital, Bragança Paulista 12916-900, SP, Brazil; (A.F.N.); (N.N.); (L.d.L.A.); (G.R.H.)
- Research Group on Technology Applied to Exercise Physiology—GTAFE, Health Sciences Postgraduate Program, São Francisco University, Bragança Paulista 12916-900, SP, Brazil; (V.B.); (L.O.K.); (I.G.M.d.R.); (P.P.M.S.)
| | - Vanessa Bertolucci
- Research Group on Technology Applied to Exercise Physiology—GTAFE, Health Sciences Postgraduate Program, São Francisco University, Bragança Paulista 12916-900, SP, Brazil; (V.B.); (L.O.K.); (I.G.M.d.R.); (P.P.M.S.)
| | - Luisa Oliveira Kaneko
- Research Group on Technology Applied to Exercise Physiology—GTAFE, Health Sciences Postgraduate Program, São Francisco University, Bragança Paulista 12916-900, SP, Brazil; (V.B.); (L.O.K.); (I.G.M.d.R.); (P.P.M.S.)
| | - Nilson Nonose
- Centre of Orthopedics Research, São Francisco University Hospital, Bragança Paulista 12916-900, SP, Brazil; (A.F.N.); (N.N.); (L.d.L.A.); (G.R.H.)
| | - Luiza di Loreto Abreu
- Centre of Orthopedics Research, São Francisco University Hospital, Bragança Paulista 12916-900, SP, Brazil; (A.F.N.); (N.N.); (L.d.L.A.); (G.R.H.)
| | - Gabriel Rodrigues Harfuch
- Centre of Orthopedics Research, São Francisco University Hospital, Bragança Paulista 12916-900, SP, Brazil; (A.F.N.); (N.N.); (L.d.L.A.); (G.R.H.)
| | - Ivan Gustavo Masselli dos Reis
- Research Group on Technology Applied to Exercise Physiology—GTAFE, Health Sciences Postgraduate Program, São Francisco University, Bragança Paulista 12916-900, SP, Brazil; (V.B.); (L.O.K.); (I.G.M.d.R.); (P.P.M.S.)
| | - Pedro Paulo Menezes Scariot
- Research Group on Technology Applied to Exercise Physiology—GTAFE, Health Sciences Postgraduate Program, São Francisco University, Bragança Paulista 12916-900, SP, Brazil; (V.B.); (L.O.K.); (I.G.M.d.R.); (P.P.M.S.)
| | - Leonardo Henrique Dalcheco Messias
- Research Group on Technology Applied to Exercise Physiology—GTAFE, Health Sciences Postgraduate Program, São Francisco University, Bragança Paulista 12916-900, SP, Brazil; (V.B.); (L.O.K.); (I.G.M.d.R.); (P.P.M.S.)
| |
Collapse
|
2
|
Belangero WD, Fogagnolo F, Kojima KE, Miguel GCDE, Bidolegui F, Bertune AD, Lombardo E, Dias ADEL, Torres JBM, Coutinho BP, Silva JDS, Leonhardt MDEC, Pereira PS, Mariolani JRL, Giordano V. Isolated open tibial shaft fracture: a seven-hospital, prospective observational study in two Latin America countries. Rev Col Bras Cir 2022; 49:e20223301. [PMID: 36449940 PMCID: PMC10578785 DOI: 10.1590/0100-6991e-20223301-en] [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: 02/11/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR). METHODS patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status. RESULTS Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score. CONCLUSIONS Isolated open tibial shaft fractures are potentially harmful to the patient's quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.
Collapse
Affiliation(s)
- William Dias Belangero
- - Universidade Estadual de Campinas, Faculdade de Ciências Médicas - Campinas - SP - Brasil
| | - Fabricio Fogagnolo
- - Universidade de São Paulo, Faculdade de Medicina - Ribeirão Preto - SP - Brasil
| | - Kodi Edson Kojima
- - Universidade de São Paulo, Instituto de Ortopedia e Traumatologia - São Paulo - SP - Brasil
| | | | | | | | - Ernesto Lombardo
- - Hospital de Emergencias Clemente Alvarez - Rosario - Santa Fé - Argentina
| | - Adélio DE Lima Dias
- - Universidade Estadual de Campinas, Faculdade de Ciências Médicas - Campinas - SP - Brasil
| | | | - Bruno Parilha Coutinho
- - Hospital Municipal Miguel Couto, Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro - Rio de Janeiro - RJ - Brasil
| | - Jorge Dos Santos Silva
- - Universidade de São Paulo, Instituto de Ortopedia e Traumatologia - São Paulo - SP - Brasil
| | | | | | | | - Vincenzo Giordano
- - Hospital Municipal Miguel Couto, Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro - Rio de Janeiro - RJ - Brasil
| |
Collapse
|
3
|
Timm K, Walter N, Heinrich M, Knapp G, Thormann U, El Khassawna T, Alt V, Heiss C, Rupp M. Influence of Thoracic Trauma on Fracture Healing in Long Bones-A Retrospective Analysis. J Clin Med 2022; 11:jcm11030717. [PMID: 35160169 PMCID: PMC8837065 DOI: 10.3390/jcm11030717] [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: 11/19/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: Pre-clinical studies indicate that concomitant thoracic trauma impairs fracture healing of long bones and reduces callus formation. The aim of this study was to investigate whether patients with accompanying chest trauma suffer from delayed fracture healing of long bones in comparison with patients with fractures of two long bones or isolated fractures. Patients and Methods: This is a clinical retrospective study from a level I trauma center. The patients were divided into three groups: (1) thoracic trauma and fracture of a long bone, (2) fractures of two long bones, (3) isolated fracture of a long bone. The fracture consolidation was defined using the radiographic union scale in tibial fractures (RUST). A RUST value of ≥10 six-to-eight months after definitive operative intervention represented complete fracture healing. Results: In the first group 19 (43.2%) fractures did not show full consolidation, in the second group 14 (45.2%) and 13 (41.9%) and in the third group 14 (36.8%). The analysis revealed no statistically significant differences between the groups regarding consolidation of the fractures six-to-eight months after definitive operative intervention (p = 0.84). Conclusions: Unlike previously reported pre-clinical data, this study did not demonstrate a negative effect on fracture consolidation in long bones when accompanied by thoracic trauma. Furthermore, the results demonstrated that concomitant fractures of two long bones does not have a negative effect on fracture consolidation.
Collapse
Affiliation(s)
- Karsten Timm
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Martin Heinrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Ulrich Thormann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Thaqif El Khassawna
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Laboratory for Experimental Trauma Surgery, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | - Volker Alt
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Laboratory for Experimental Trauma Surgery, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | - Markus Rupp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
- Correspondence:
| |
Collapse
|
4
|
Kröger I, Müßig J, Brand A, Pätzold R, Wackerle H, Klöpfer-Krämer I, Augat P. Recovery of gait and function during the first six months after tibial shaft fractures. Gait Posture 2022; 91:66-72. [PMID: 34653876 DOI: 10.1016/j.gaitpost.2021.09.199] [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: 05/11/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial shaft fractures require surgical stabilization preferably by intramedullary nailing. Recovery is often unsatisfactory due to limited knee function and pain, resulting in reduced quality of life. The extent of these functional limitations with respect to gait deficits has not been sufficiently recognized. RESEARCH QUESTION Are there functional limitations during gait and squat performance during the first six months after surgically treated tibial shaft fractures? METHODS Twenty-three patients (BMI: 24 ± 3, Age:39 ± 15) with tibial shaft fractures and 23 healthy, matched controls (BMI: 24 ± 3, Age: 40 ± 14) were assessed using instrumented motion analysis two, three and six months after surgery. Kinematic and kinetic data of the lower extremities were collected during level walking and squat performance. Data were compared among follow-up time intervals and between groups. RESULTS Significant improvements were found for all spatiotemporal parameters and most kinetic parameters. Even six months after surgery functional deficits persisted when compared to healthy controls. There were only slight improvements in sagittal knee and ankle kinematics as well as knee moments and power within the follow-up period. A significant difference compared to the healthy controls can still be observed in these parameters. SIGNIFICANCE Although patients with tibia fractures demonstrated functional improvements over the early course of healing, some residual deficits in lower extremity movement biomechanics were identified at six months post surgery. In particular knee kinematics in squatting as well as knee kinematics and kinetics during walking only recovered incompletely. This result can help explain the often-reported functional limitations. CLINICAL TRIAL REGISTRATION NUMBER German register for clinical trials (DRKS00023790).
Collapse
Affiliation(s)
- Inga Kröger
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria.
| | - Janina Müßig
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Andreas Brand
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Robert Pätzold
- Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Germany
| | - Hannes Wackerle
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Isabella Klöpfer-Krämer
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| |
Collapse
|
5
|
BELANGERO WILLIAMDIAS, FOGAGNOLO FABRICIO, KOJIMA KODIEDSON, MIGUEL GUILHERMECHOHFIDE, BIDOLEGUI FERNANDO, BERTUNE ALEJANDRODANIEL, LOMBARDO ERNESTO, DIAS ADÉLIODELIMA, TORRES JOÃOBATISTAMANZOLI, COUTINHO BRUNOPARILHA, SILVA JORGEDOSSANTOS, LEONHARDT MARCOSDECAMARGO, PEREIRA PABLOSEBASTIÁN, MARIOLANI JOSÉRICARDOLENZI, GIORDANO VINCENZO. Fraturas expostas isoladas da diáfise da tíbia: estudo prospectivo observacional em sete hospitais de dois países da América Latina. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RESUMO Introdução: o tratamento de fraturas expostas isoladas da diáfise da tíbia (FEIDT) apresenta desafios por frequentemente associar severa lesão óssea com condições ruins de tecido mole, fatores relevantes em países de média e baixa renda, especialmente devido a atrasos na implementação da fixação definitiva e falta de treinamento adequado no manejo de tecidos moles. Consequentemente, FEIDTs representam importante fonte de incapacitação na América Latina. Este estudo objetivou apresentar uma visão geral das FEIDTs em sete hospitais do cone sul da América Latina. O objetivo secundário foi avaliar o seu impacto na qualidade de vida baseado na taxa de retorno ao trabalho (TRT). Métodos: foram incluídos no estudo pacientes com FEIDT tratados em sete hospitais de Brasil e Argentina entre novembro de 2017 e março de 2020. Resultados clínicos e radiográficos foram analisados num período de 120 dias. Avaliação final comparou TRT com o questionário SF-12, consolidação óssea e condições de marcha. Resultados: setenta e dois pacientes foram tratados, 57 seguidos por 120 dias e 48 completaram o questionário SF-12. Após 120 dias, 70,6% havia retornado ao trabalho, 61,4% tinha fratura consolidada. Idade, antibioticoterapia, tipo de tratamento definitivo e infecção influenciaram significativamente na TRT. A condição de marcha apresentou forte correlação com TRT e o componente físico do SF-12. Conclusão: FEIDTs são potencialmente deletérias à qualidade de vida dos pacientes 120 dias após o tratamento inicial. TRT é significativamente maior para pacientes mais jovens, sem história de infecção e que conseguem correr na avaliação da condição de marcha..
Collapse
|
6
|
Larsen P, Eriksen CB, Stokholm R, Elsoe R. Results following prolonged recovery show satisfactory functional and patient-reported outcome after intramedullary nailing of a tibial shaft fracture: a prospective 5-year follow-up cohort study. Arch Orthop Trauma Surg 2021; 141:1303-1310. [PMID: 32951059 DOI: 10.1007/s00402-020-03608-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Although a large number of previous studies have investigated the outcome in patients following tibial shaft fractures, the literature provides limited information on prospectively reported patients with mid- to long-term follow-up. The present study aimed to investigate prospectively the 5-year development in patient-reported quality of life after intramedullary nailing of a tibial shaft fracture. MATERIAL AND METHODS The design was a prospective, 5-year follow-up cohort study. Quality of life (QOL) was measured with the questionnaire Eq5d-5L and compared to the 1-year outcome reported by the same patients. Secondary outcome measurements were the Knee Injury and Osteoarthritis Outcome Score (KOOS), recordings of pain, gait and muscle strength. RESULTS Twenty-nine patients were eligible for participation. Mean patient age at the time of the 5-year follow-up was 46.3 years. The 5-year postoperative mean Eq5d-5L index was 0.864 (95% CI 0.809-0.918). The mean Eq5d-5L VAS was 88.4 (95% CI 83.4-93.5). Compared with the same patients' Eq5d-5L index scores at the 1-year follow-up (0.784), a significant increase was observed (P = 0.014). A comparison to the Danish Eq.5D reference population showed no statistically significant difference. CONCLUSIONS Patient-reported quality of life among patients treated with intramedullary nailing following a tibial shaft fracture increased significantly between the 1-year and 5-year follow-up. In contrast to the 1-year patient-reported quality of life, results are comparable to those of a reference population at the 5-year follow-up. In a clinical setting, these results highlight that patients may expect a prolonged period to recover. However, of most importance is that patients can expect a satisfactory outcome years after fracture and treatment.
Collapse
Affiliation(s)
- Peter Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark. .,Department of Orthopaedic Trauma Surgery, Aalborg University Hospital, 18-22 Hobrovej, 9000, Aalborg, Denmark.
| | - Christian Berre Eriksen
- Department of Orthopaedic Trauma Surgery, Aalborg University Hospital, 18-22 Hobrovej, 9000, Aalborg, Denmark
| | - Rasmus Stokholm
- Department of Orthopaedic Trauma Surgery, Aalborg University Hospital, 18-22 Hobrovej, 9000, Aalborg, Denmark
| | - Rasmus Elsoe
- Department of Orthopaedic Trauma Surgery, Aalborg University Hospital, 18-22 Hobrovej, 9000, Aalborg, Denmark
| |
Collapse
|
7
|
Maharjan R, Pokharel B, Shah Kalawar RP, Rijal R, Baral D. Squat and smile assessment in predicting healing of lower limb fractures fixed with a SIGN nail. J Clin Orthop Trauma 2021; 19:34-41. [PMID: 34046298 PMCID: PMC8141930 DOI: 10.1016/j.jcot.2021.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Irrespective of the treatment method, union is the ultimate goal of any fracture treatment. However, nowadays, rather than the physician-based clinico-radiological methods, the patient-reported outcome measurements assessing their quality of life and function are gaining much popularity. This is specifically true in the part of the world where the patient needs almost complete degree of hip/knee flexion - for social, cultural, religious or occupational reason(s). The ability to squat can assess the mobility and stability of joints and thus the quality of squatting is a proxy reflection of the functional outcome after fixation of lower limb fracture. Thus, we studied to determine the inter-observer and intra-observer reliability of Radiographic Union Score for Tibia (RUST) and Squat and Smile (S & S) test in clinical photograph. We further calculated the sensitivity and specificity of S & S test in predicting healing of lower limb fracture fixed by intramedullary interlocking nail considering RUST as the gold standard. METHODS This was a retrospective study of prospectively collected data of solid Surgical Implant Generation Network (SIGN) intramedullary interlocking nailing from a single, university-based, high volume tertiary center where 56 consecutive adults with either tibial or femoral shaft fractures fixed with a SIGN nail within one year and not requiring any surgery till minimum of eighteen-month follow-up were included. Cases without either Anterior-Posterior (AP) view and/or Lateral (Lat.) view follow-up x-ray(s) or proper S & S clinical photograph (at least 1.5-year post fixation) were excluded. The x-rays (RUST criteria) and clinical photograph (S & S grading) were scored by two independent and blinded observers each and repeated after 1 month. RESULTS The overall intra-observer reliability was from 0.773 to 0.825 and inter-observer reliability from 0.635 to 0.757 for RUST scoring which was from 0.687 to 0.785 and from 0.301 to 0.650 respectively for S & S scoring. The sensitivity and specificity of S & S in predicting fracture healing were up to 82.22% and 63.64% respectively. CONCLUSION The S & S test is reliable to predict the healing of lower limb fracture fixed with an intramedullary nail. The test is more useful to determine healed fractures than to determine non-healed ones. (sensitivity being higher than specificity).
Collapse
Affiliation(s)
- Rajiv Maharjan
- Department of Orthopedics, BP Koirala Institute of Health Sciences, Dharan, 56700, Koshi, Nepal
- Corresponding author.
| | - Bishnu Pokharel
- Department of Orthopedics, BP Koirala Institute of Health Sciences, Dharan, 56700, Koshi, Nepal
| | | | - Raju Rijal
- Department of Orthopedics, BP Koirala Institute of Health Sciences, Dharan, 56700, Koshi, Nepal
| | - Dharanidhar Baral
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, 56700, Koshi, Nepal
| |
Collapse
|
8
|
Shen H, Gardner AM, Vyas J, Ishida R, Tawfik VL. Modeling Complex Orthopedic Trauma in Rodents: Bone, Muscle and Nerve Injury and Healing. Front Pharmacol 2021; 11:620485. [PMID: 33597884 PMCID: PMC7882733 DOI: 10.3389/fphar.2020.620485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/21/2020] [Indexed: 12/24/2022] Open
Abstract
Orthopedic injury can occur from a variety of causes including motor vehicle collision, battlefield injuries or even falls from standing. Persistent limb pain is common after orthopedic injury or surgery and presents a unique challenge, as the initiating event may result in polytrauma to bone, muscle, and peripheral nerves. It is imperative that we understand the tissue-specific and multicellular response to this unique type of injury in order to best develop targeted treatments that improve healing and regeneration. In this Mini Review we will first discuss current rodent models of orthopedic trauma/complex orthotrauma. In the second section, we will focus on bone-specific outcomes including imaging modalities, biomechanical testing and immunostaining for markers of bone healing/turnover. In the third section, we will discuss muscle-related pathology including outcome measures of fibrosis, muscle regeneration and tensile strength measurements. In the fourth section, we will discuss nervous system-related pathology including outcome measures of pain-like responses, both reflexive and non-reflexive. In all sections we will consider parallels between preclinical outcome measures and the functional and mechanistic findings of the human condition.
Collapse
Affiliation(s)
- Huaishuang Shen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States.,Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Aysha M Gardner
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States
| | - Juhee Vyas
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States
| | - Ryosuke Ishida
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States.,Department of Anesthesiology, Shimane University, Shimane, Japan
| | - Vivianne L Tawfik
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States.,Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, United States
| |
Collapse
|
9
|
Maharjan R, Shrestha BP, Chaudhary P, Rijal R, Shah Kalawar RP. Functional outcome of patients of tibial fracture treated with solid nail (SIGN nail) versus conventional hollow nail - A randomized trial. J Clin Orthop Trauma 2021; 12:148-160. [PMID: 33716440 PMCID: PMC7920208 DOI: 10.1016/j.jcot.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/05/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Trauma related disabilities disproportionately affects low and middle income countries due to lack of resources, skills and optimal implants. Despite adequate animal studies, biomechanical studies, cohort studies and comparison studies we are not aware of any randomized trial to compare the functional outcome of SIGN (Surgical Implant Generation Network, US) solid nailing with a hollow nailing for tibial shaft fracture. METHODS Sixty patients (≥16 years) of closed and Gustilo grade I traumatic fractures of the leg were randomized into SIGN solid nailing or hollow nailing group. Cases with compromised soft tissue and grossly deformed medullary canal were excluded. Functional outcome and need for resurgery were the primary outcomes while the secondary outcomes were duration of surgery, intraoperative blood loss, overall pain (VAS), radiological union (RUST), surgery related complications (infection, malalignment, shortening, nonunion) and pain/range of motion (ROM) of knee/ankle. All SIGN surgery related data were entered and retrieved online from www.signsurgery.org. RESULT The demographical parameters were symmetrically distributed between the groups (p > 0.05). 2 cases in SIGN nailing and 4 cases in hollow nailing needed open reduction. The functional outcome, as assessed by blinded physiotherapist using Johner and Wruh criteria, was excellent in 18 (62.06%), good in 6 (20.68%), fair in 3 (10.34%) and poor in 2 (6.89%) for SIGN nail whereas it was 16 (57.14%), 8 (28.57%), 3 (10.71%) and 1 (3.57%) respectively for hollow nail. There was 1 case of implant failure and 1 case of infection. Intraoperative blood loss (397 ± 94.47 ml versus 350 ± 75.43 ml, p = 0.037) and duration of surgery (94.8 ± 14.57 min versus 82.0 ± 12.36 min, p = 0.001) were significantly more in hollow nailing group. At final follow up, overall pain on weight bearing (VAS score) and radiological union (RUST score) were 2.1 and 11.7 for SIGN nailing while they were 2.7 and 11.3 respectively for hollow nailing.(p = 0.41 and 0.45 respectively) The malrotation (p = 1.000), shortening (p = 1.000), varus-valgus angulation (p = 0.511), AP angulation (p = 0.706), ROM ankle (p = 0.239) and ROM knee (p = 0.086) were similar. CONCLUSION Solid SIGN nailing gives comparable functional outcome as conventional hollow nailing for tibia shaft fracture. For developing world with limited resources, SIGN nail is useful which is supplied freely and is designed to be used without image intensifier and fracture table.
Collapse
|
10
|
Sunarya U, Sun Hariyani Y, Cho T, Roh J, Hyeong J, Sohn I, Kim S, Park C. Feature Analysis of Smart Shoe Sensors for Classification of Gait Patterns. SENSORS 2020; 20:s20216253. [PMID: 33147794 PMCID: PMC7662266 DOI: 10.3390/s20216253] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/30/2022]
Abstract
Gait analysis is commonly used to detect foot disorders and abnormalities such as supination, pronation, unstable left foot and unstable right foot. Early detection of these abnormalities could help us to correct the walking posture and avoid getting injuries. This paper presents extensive feature analyses on smart shoes sensor data, including pressure sensors, accelerometer and gyroscope signals, to obtain the optimum combination of the sensors for gait classification, which is crucial to implement a power-efficient mobile smart shoes system. In addition, we investigated the optimal length of data segmentation based on the gait cycle parameters, reduction of the feature dimensions and feature selection for the classification of the gait patterns. Benchmark tests among several machine learning algorithms were conducted using random forest, k-nearest neighbor (KNN), logistic regression and support vector machine (SVM) algorithms for the classification task. Our experiments demonstrated the combination of accelerometer and gyroscope sensor features with SVM achieved the best performance with 89.36% accuracy, 89.76% precision and 88.44% recall. This research suggests a new state-of-the-art gait classification approach, specifically on detecting human gait abnormalities.
Collapse
Affiliation(s)
- Unang Sunarya
- Department of Computer Engineering, Kwangwoon University, Seoul 01897, Korea; (U.S.); (Y.S.H.)
- School of Applied Science, Telkom University, Bandung 40257, Indonesia
| | - Yuli Sun Hariyani
- Department of Computer Engineering, Kwangwoon University, Seoul 01897, Korea; (U.S.); (Y.S.H.)
- School of Applied Science, Telkom University, Bandung 40257, Indonesia
| | - Taeheum Cho
- Department of Intelligent Information and Embedded Software Engineering, Kwangwoon University, Seoul 01897, Korea;
| | - Jongryun Roh
- Human Convergence Technology R&D Department, Korea Institute of Industrial Technology, Ansan 15588, Korea; (J.R.); (J.H.)
| | - Joonho Hyeong
- Human Convergence Technology R&D Department, Korea Institute of Industrial Technology, Ansan 15588, Korea; (J.R.); (J.H.)
| | - Illsoo Sohn
- Department of Computer Science and Engineering Seoul National University of Science and Technology, Seoul 01811, Korea;
| | - Sayup Kim
- Human Convergence Technology R&D Department, Korea Institute of Industrial Technology, Ansan 15588, Korea; (J.R.); (J.H.)
- Correspondence: (S.K.); (C.P.); Tel.: +82-2-940-8251 (C.P.)
| | - Cheolsoo Park
- Department of Computer Engineering, Kwangwoon University, Seoul 01897, Korea; (U.S.); (Y.S.H.)
- Correspondence: (S.K.); (C.P.); Tel.: +82-2-940-8251 (C.P.)
| |
Collapse
|
11
|
Observational Gait Assessment Scales in Patients with Walking Disorders: Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2085039. [PMID: 31781597 PMCID: PMC6875351 DOI: 10.1155/2019/2085039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/01/2019] [Accepted: 09/18/2019] [Indexed: 11/18/2022]
Abstract
Objective To compile and analyze the characteristics and methodological quality of observational gait assessment scales validated to date. Methods PubMed, Scopus, the Cochrane Library, Physiotherapy Evidence Database, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Dialnet, Spanish Medical Index, and Nursing, Physiotherapy, and Podiatry databases were searched up to August 2019. The main inclusion criteria were validated tools based on a conceptual framework developed to evaluate gait, validation design studies of observational scales in their entirety, and articles written in English or Spanish. Evaluators extracted descriptive information of the scales and the metric properties of the studies, which were further analyzed with Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN checklist). Results Eighteen articles based on 14 scales were included. The populations were neurological patients (72.22%), musculoskeletal disorders (11.11%), and other areas such as vestibular disorders (11.11%). The most addressed items were orthopedic aids (64.29%); phases of the gait cycle and kinematics of the leg and trunk (57.14% each one); and spatial and temporal parameters (50%). All studies analyzed criterion validity, and five included content or structural validity (27.78%). Fifteen articles considered reliability (83.33%). Regarding the seven-item scale QUADAS-2, five studies obtained six results on “low” risk of bias or “low” concerns regarding applicability. Nine articles obtained at least a “fair” result on COSMIN checklist. Conclusions A necessary compilation of the observational gait assessment scales validated to date was conducted. Besides, their characteristics and methodological quality were analyzed. Most scales were applied in neurological signs. The most approached topics were orthopedic aids, phases of the gait cycle, and kinematics of the leg and trunk. The scale that demonstrated a higher methodological quality was Visual Gait Assessment Scale, followed by CHAGS, Salford Gait Tool, and Edinburgh Visual Gait Score.
Collapse
|
12
|
Lajevardi-Khosh A, Tresco B, Stuart A, Sinclair S, Ackerman M, Kubiak E, Petelenz T, Hitchcock R. Development of a step counting algorithm using the ambulatory tibia load analysis system for tibia fracture patients. J Rehabil Assist Technol Eng 2019; 5:2055668318804974. [PMID: 31191958 PMCID: PMC6531803 DOI: 10.1177/2055668318804974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/13/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction: Ambulation can be used to monitor the healing of lower
extremity fractures. However, the ambulatory behavior of tibia fracture patients
remains unknown due to an inability to continuously quantify ambulation outside
of the clinic. The goal of this study was to design and validate an algorithm to
assess ambulation in tibia fracture patients using the ambulatory tibial load
analysis system during recovery, outside of the clinic.
Collapse
Affiliation(s)
| | - Ben Tresco
- Department of Chemistry, University of Utah, Salt Lake City, UT, USA
| | - Ami Stuart
- Department of Orthopaedics, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA
| | - Sarina Sinclair
- Department of Orthopaedics, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA
| | - Matt Ackerman
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Erik Kubiak
- Department of Orthopaedics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Tomasz Petelenz
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Robert Hitchcock
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
13
|
Christiano AV, Goch AM, Leucht P, Konda SR, Egol KA. Radiographic union score for tibia fractures predicts success with operative treatment of tibial nonunion. J Clin Orthop Trauma 2019; 10:650-654. [PMID: 31316233 PMCID: PMC6611993 DOI: 10.1016/j.jcot.2018.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the ability of preoperative and postoperative radiographic union scores for tibia fractures (RUST) to predict treatment success of tibia fracture nonunion. MATERIALS AND METHODS Patients presenting for operative treatment of tibia fracture nonunion were enrolled in a prospective data registry. Enrolled patients were followed at regular intervals for 12 months. Preoperative and 12 week postoperative radiographs were reviewed and scored using the RUST criteria. Postoperative time to union was determined by clinical and radiographic measures. Multivariate regressions were conducted to predict time to union using preoperative and postoperative RUST while controlling for treatment method. Receiver operating characteristic (ROC) curve was conducted to determine the accuracy of preoperative RUST in predicting failure of treatment. RESULTS Sixty-eight patients with aseptic tibia fracture nonunion treated operatively were identified. Sixty-one patients achieved union. Mean preoperative RUST was 7.5 (SD 1.4). Mean postoperative RUST was 9.2 (SD 1.4). Multivariate linear regressions demonstrated that preoperative (p = 0.043) and postoperative (p = 0.007) RUST are significant predictors of time to union after tibia fracture nonunion surgery. ROC curve demonstrated preoperative RUST below 7 was a good predictor of developing persistent tibia fracture nonunion (AUC = 0.83, Sensitivity = 1.000, Specificity = 0.745). CONCLUSIONS RUST preoperatively and postoperatively predicts outcome after nonunion surgery. RUST can be used as part of the complete clinical picture to shape patient expectations and guide treatment.
Collapse
Affiliation(s)
- Anthony V. Christiano
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Corresponding author. 1 Gustave L Levy Pl, Box 1188, New York, NY, 10029, USA.
| | | | | | - Sanjit R. Konda
- NYU Hospital for Joint Diseases, New York, NY, USA,Jamaica Hospital Medical Center, New York, NY, USA
| | | |
Collapse
|
14
|
Braun BJ, Veith NT, Rollmann M, Orth M, Fritz T, Herath SC, Holstein JH, Pohlemann T. Weight-bearing recommendations after operative fracture treatment—fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole. INTERNATIONAL ORTHOPAEDICS 2017; 41:1507-1512. [DOI: 10.1007/s00264-017-3481-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/03/2017] [Indexed: 11/24/2022]
|
15
|
Reprodutibilidade do escore radiográfico de consolidação das fraturas da tíbia (RUST). Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
16
|
Larsen P, Laessoe U, Rasmussen S, Graven-Nielsen T, Berre Eriksen C, Elsoe R. Asymmetry in gait pattern following tibial shaft fractures - a prospective one-year follow-up study of 49 patients. Gait Posture 2017; 51:47-51. [PMID: 27701034 DOI: 10.1016/j.gaitpost.2016.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite the high number of studies evaluating the outcomes following tibial shaft fractures, the literature lacks studies including objective assessment of patients' recovery regarding gait pattern. The purpose of the present study was to evaluate whether gait patterns at 6 and 12 months post-operatively following intramedullary nailing of a tibial shaft fracture are different compared with a healthy reference population. PATIENTS AND METHODS The study design was a prospective cohort study. The primary outcome measurement was the gait patterns at 6 and 12 months post-operatively measured with a 6-metre-long pressure-sensitive mat. The mat registers footprints and present gait speed, cadence as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. RESULTS 49 patients were included with a mean age of 43.1 years (18-79 years). Forty-three patients completed the 12-month follow-up (88%). Gait speed and cadence were significantly increased between the 6- and 12-month follow-up (P<0.001). At 6-month follow-up, patients showed considerable asymmetry in the injured leg compared with the non-injured leg: single-support time 12.8% shorter, swing-time 12.8% longer, step-length 11.9% shorter, and rotation of the foot increased by 32.3%. At the 12-month follow-up, gait asymmetry become almost normalized compared to a healthy reference group. CONCLUSION In patients treated by intramedullary nailing following a tibial shaft fracture, gait asymmetry accompanied with slower speed and cadence are common during the first 6 months and become normalized compared with a healthy reference population between 6 and 12 months post-operatively.
Collapse
Affiliation(s)
- Peter Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Denmark.
| | - Uffe Laessoe
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Physiotherapy Department, University College North Denmark, UCN, Denmark.
| | - Sten Rasmussen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark.
| | | | - Rasmus Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Denmark.
| |
Collapse
|
17
|
Azevedo Filho FASD, Cotias RB, Azi ML, Teixeira AADA. Reliability of the radiographic union scale in tibial fractures (RUST). Rev Bras Ortop 2016; 52:35-39. [PMID: 28194379 PMCID: PMC5290129 DOI: 10.1016/j.rboe.2016.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/03/2016] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed to evaluate the inter- and intra observer reproducibility of the radiographic score of consolidation of the tibia shaft fractures. Methods Fifty-one sets of radiographs in anteroposterior (AP) and profile (P) of the tibial shaft treated with intramedullary nail were obtained. The analysis of X-rays was performed in two stages, with a 21-day interval between assessments by a group of nine evaluators. To evaluate the reproducibility of RUST score between the evaluators, the intra-class correlation coefficient (ICC) with a 95% confidence interval was used. ICC values range from +1, representing perfect agreement, to −1, complete disagreement. Results There was a significant correlation among all evaluators: ICC = 0.87 (95% CI 0.81 to 0.91). The intraobserver agreement proved to be substantial with ICC = 0.88 (95% CI 0.85 to 0.91). Conclusion This study confirms that the RUST scale shows a high degree of reliability and agreement.
Collapse
|
18
|
Braun BJ, Wrona J, Veith NT, Rollman M, Orth M, Herath SC, Holstein JH, Pohlemann T. Predictive value of clinical scoring and simplified gait analysis for acetabulum fractures. J Surg Res 2016; 206:405-410. [PMID: 27884336 DOI: 10.1016/j.jss.2016.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/29/2016] [Accepted: 08/15/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fractures of the acetabulum show a high, long-term complication rate. The aim of the present study was to determine the predictive value of clinical scoring and standardized, simplified gait analysis on the outcome after these fractures. METHODS Forty-one patients with acetabular fractures treated between 2008 and 2013 and available, standardized video recorded aftercare were identified from a prospective database. A visual gait score was used to determine the patients walking abilities 6-m postoperatively. Clinical (Merle d'Aubigne and Postel score, visual analogue scale pain, EQ5d) and radiological scoring (Kellgren-Lawrence score, postoperative computed tomography, and Matta classification) were used to perform correlation and multivariate regression analysis. RESULTS The average patient age was 48 y (range, 15-82 y), six female patients were included in the study. Mean follow-up was 1.6 y (range, 1-2 y). Moderate correlation between the gait score and outcome (versus EQ5d: rs = 0.477; versus Merle d'Aubigne: rs = 0.444; versus Kellgren-Lawrence: rs = -0.533), as well as high correlation between the Merle d'Aubigne score and outcome were seen (versus EQ5d: rs = 0.575; versus Merle d'Aubigne: rs = 0.776; versus Kellgren-Lawrence: rs = -0.419). Using a multivariate regression model, the 6 m gait score (B = -0.299; P < 0.05) and early osteoarthritis development (B = 1.026; P < 0.05) were determined as predictors of final osteoarthritis. A good fit of the regression model was seen (R2 = 904). CONCLUSIONS Easy and available clinical scoring (gait score/Merle d'Aubigne) can predict short-term radiological and functional outcome after acetabular fractures with sufficient accuracy. Decisions on further treatment and interventions could be based on simplified gait analysis.
Collapse
Affiliation(s)
- Benedikt J Braun
- Department for Trauma, Hand, and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany.
| | - Julian Wrona
- Department for Trauma, Hand, and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Nils T Veith
- Department for Trauma, Hand, and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Mika Rollman
- Department for Trauma, Hand, and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Marcel Orth
- Department for Trauma, Hand, and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Steven C Herath
- Department for Trauma, Hand, and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Jörg H Holstein
- Department for Trauma, Hand, and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - Tim Pohlemann
- Department for Trauma, Hand, and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| |
Collapse
|
19
|
Braun BJ, Bushuven E, Hell R, Veith NT, Buschbaum J, Holstein JH, Pohlemann T. A novel tool for continuous fracture aftercare - Clinical feasibility and first results of a new telemetric gait analysis insole. Injury 2016; 47:490-4. [PMID: 26626806 DOI: 10.1016/j.injury.2015.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Weight bearing after lower extremity fractures still remains a highly controversial issue. Even in ankle fractures, the most common lower extremity injury no standard aftercare protocol has been established. Average non weight bearing times range from 0 to 7 weeks, with standardised, radiological healing controls at fixed time intervals. Recent literature calls for patient-adapted aftercare protocols based on individual fracture and load scenarios. We show the clinical feasibility and first results of a new, insole embedded gait analysis tool for continuous monitoring of gait, load and activity. Ten patients were monitored with a new, independent gait analysis insole for up to 3 months postoperatively. Strict 20 kg partial weight bearing was ordered for 6 weeks. Overall activity, load spectrum, ground reaction forces, clinical scoring and general health data were recorded and correlated. Statistical analysis with power analysis, t-test and Spearman correlation was performed. Only one patient completely adhered to the set weight bearing limit. Average time in minutes over the limit was 374 min. Based on the parameters load, activity, gait time over 20 kg weight bearing and maximum ground reaction force high and low performers were defined after 3 weeks. Significant difference in time to painless full weight bearing between high and low performers was shown. Correlation analysis revealed a significant correlation between weight bearing and clinical scoring as well as pain (American Orthopaedic Foot and Ankle Society (AOFAS) Score rs=0.74; Olerud-Molander Score rs=0.93; VAS pain rs=-0.95). Early, continuous gait analysis is able to define aftercare performers with significant differences in time to full painless weight bearing where clinical or radiographic controls could not. Patient compliance to standardised weight bearing limits and protocols is low. Highly individual rehabilitation patterns were seen in all patients. Aftercare protocols should be adjusted to real-time patient conditions, rather than fixed intervals and limits. With a real-time measuring device high performers could be identified and influenced towards optimal healing conditions early, while low performers are recognised and missing healing influences could be corrected according to patient condition.
Collapse
Affiliation(s)
- Benedikt J Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany.
| | - Eva Bushuven
- Department of Diagnostic and Interventional Radiology, Saarland University Hospital, Germany
| | - Rebecca Hell
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Nils T Veith
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Jan Buschbaum
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Joerg H Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| |
Collapse
|
20
|
Fountain S, Windolf M, Henkel J, Tavakoli A, Schuetz MA, Hutmacher DW, Epari DR. Monitoring Healing Progression and Characterizing the Mechanical Environment in Preclinical Models for Bone Tissue Engineering. TISSUE ENGINEERING PART B-REVIEWS 2015; 22:47-57. [PMID: 26507933 DOI: 10.1089/ten.teb.2015.0123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The treatment of large segmental bone defects remains a significant clinical challenge. Due to limitations surrounding the use of bone grafts, tissue-engineered constructs for the repair of large bone defects could offer an alternative. Before translation of any newly developed tissue engineering (TE) approach to the clinic, efficacy of the treatment must be shown in a validated preclinical large animal model. Currently, biomechanical testing, histology, and microcomputed tomography are performed to assess the quality and quantity of the regenerated bone. However, in vivo monitoring of the progression of healing is seldom performed, which could reveal important information regarding time to restoration of mechanical function and acceleration of regeneration. Furthermore, since the mechanical environment is known to influence bone regeneration, and limb loading of the animals can poorly be controlled, characterizing activity and load history could provide the ability to explain variability in the acquired data sets and potentially outliers based on abnormal loading. Many approaches have been devised to monitor the progression of healing and characterize the mechanical environment in fracture healing studies. In this article, we review previous methods and share results of recent work of our group toward developing and implementing a comprehensive biomechanical monitoring system to study bone regeneration in preclinical TE studies.
Collapse
Affiliation(s)
| | - Markus Windolf
- 1 Queensland University of Technology , Brisbane, Australia .,2 AO Research Institute Davos , Davos, Switzerland
| | - Jan Henkel
- 1 Queensland University of Technology , Brisbane, Australia
| | | | - Michael A Schuetz
- 1 Queensland University of Technology , Brisbane, Australia .,3 Trauma Service, Princess Alexandra Hospital , Brisbane, Australia
| | | | | |
Collapse
|
21
|
Braun BJ, Veith NT, Hell R, Döbele S, Roland M, Rollmann M, Holstein J, Pohlemann T. Validation and reliability testing of a new, fully integrated gait analysis insole. J Foot Ankle Res 2015; 8:54. [PMID: 26396594 PMCID: PMC4578601 DOI: 10.1186/s13047-015-0111-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 09/14/2015] [Indexed: 01/05/2023] Open
Abstract
Background A new tool (OpenGo, Moticon GmbH) was introduced to continuously measure kinetic and temporospatial gait parameters independently through an insole over up to 4 weeks. The goal of this study was to investigate the validity and reliability of this new insole system in a group of healthy individuals. Methods Gait data were collected from 12 healthy individuals on a treadmill at two different speeds. In total, six trials of three minutes each were performed by every participant. Validation was performed with the FDM-S System (Zebris). Complete sensor data were used for a within test reliability analysis of over 10000 steps. Intraclass correlation was calculated for different gait parameters and analysis of variance performed. Results Intraclass correlation for the validation was >0.796 for temporospatial and kinetic gait parameters. No statistical difference was seen between the insole and force plate measurements (difference between means: 36.3 ± 27.19 N; p = 0.19 and 0.027 ± 0.028 s; p = 0.36). Intraclass correlation for the reliability was >0.994 for all parameters measured. Conclusion The system is feasible for clinical trials that require step by step as well as grouped analysis of gait over a long period of time. Comparable validity and reliability to a stationary analysis tool has been shown.
Collapse
Affiliation(s)
- Benedikt Johannes Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Nils Thomas Veith
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Rebecca Hell
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Stefan Döbele
- BG Trauma Center, Department of Trauma Surgery, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Michael Roland
- Saarland University, Chair of Applied Mechanics, Saarbruecken, Germany
| | - Mika Rollmann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Jörg Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Building 57, Kirrbergerstr. 1, 66421 Homburg, Germany
| |
Collapse
|
22
|
Braun BJ, Rollmann M, Veith N, Pohlemann T. Fracture healing redefined. Med Hypotheses 2015; 85:940-3. [PMID: 26364044 DOI: 10.1016/j.mehy.2015.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/04/2015] [Accepted: 09/04/2015] [Indexed: 01/30/2023]
Abstract
It is well established that local mechanical conditions and interfragmentary movement are important factors for successful bone healing and may vary dramatically with patient fracture-load and activity. Up until now however it was technically impossible to use these key influence parameters in the aftercare treatment process of human lower extremity fractures. We propose a theory that with state of the art sensor technology these biomechanical influences can not only be monitored in vivo, but also used for individualized therapy protocols. Local measurement systems for fracture healing are available but remain research tools, due to various technical issues. To investigate the biomechanical influences on healing right away surrogate sensor tools are needed. Various gait characteristics have been proposed as surrogate measures. Currently available sensor tools could be modified with the appropriate support structure to allow such measurements continuously over the course of a fracture healing. Interdisciplinary work between clinicians, software engineers with computer and biomechanical simulations is needed. Through such a sensor system human boundary conditions for fracture healing could not only be defined for the first time, but also used for a unique, extendible aftercare system. With this tool critical healing situations would be detected much earlier and could be prevented with easy activity modifications, reducing patient and socioeconomic burden of disease. The hypothesis, necessary tools and support structures are presented.
Collapse
Affiliation(s)
- B J Braun
- Department of Trauma-, Hand-, Reconstructive Surgery, Saarland University Hospital, Homburg, Germany.
| | - M Rollmann
- Department of Trauma-, Hand-, Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - N Veith
- Department of Trauma-, Hand-, Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - T Pohlemann
- Department of Trauma-, Hand-, Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| |
Collapse
|
23
|
Kwasnicki RM, Hettiaratchy S, Okogbaa J, Lo B, Yang GZ, Darzi A. Return of functional mobility after an open tibial fracture: a sensor-based longitudinal cohort study using the Hamlyn Mobility Score. Bone Joint J 2015. [PMID: 26224831 DOI: 10.1302/0301-620x.97b8.35491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this study we quantified and characterised the return of functional mobility following open tibial fracture using the Hamlyn Mobility Score. A total of 20 patients who had undergone reconstruction following this fracture were reviewed at three-month intervals for one year. An ear-worn movement sensor was used to assess their mobility and gait. The Hamlyn Mobility Score and its constituent kinematic features were calculated longitudinally, allowing analysis of mobility during recovery and between patients with varying grades of fracture. The mean score improved throughout the study period. Patients with more severe fractures recovered at a slower rate; those with a grade I Gustilo-Anderson fracture completing most of their recovery within three months, those with a grade II fracture within six months and those with a grade III fracture within nine months. Analysis of gait showed that the quality of walking continued to improve up to 12 months post-operatively, whereas the capacity to walk, as measured by the six-minute walking test, plateaued after six months. Late complications occurred in two patients, in whom the trajectory of recovery deviated by > 0.5 standard deviations below that of the remaining patients. This is the first objective, longitudinal assessment of functional recovery in patients with an open tibial fracture, providing some clarification of the differences in prognosis and recovery associated with different grades of fracture.
Collapse
Affiliation(s)
- R M Kwasnicki
- Imperial College London, 3rd Floor Paterson Centre, Praed Street, Paddington, W2 1NY, UK
| | - S Hettiaratchy
- Imperial College London, 3rd Floor Paterson Centre, Praed Street, Paddington, W2 1NY, UK
| | - J Okogbaa
- Stanford University, Stanford, California, USA
| | - B Lo
- Imperial College London, 3rd Floor Paterson Centre, Praed Street, Paddington, W2 1NY, UK
| | - G-Z Yang
- Imperial College London, 3rd Floor Paterson Centre, Praed Street, Paddington, W2 1NY, UK
| | - A Darzi
- Imperial College London, 3rd Floor Paterson Centre, Praed Street, Paddington, W2 1NY, UK
| |
Collapse
|
24
|
Bouffard J, Bertrand-Charette M, Roy JS. Psychometric properties of the Musculoskeletal Function Assessment and the Short Musculoskeletal Function Assessment: a systematic review. Clin Rehabil 2015; 30:393-409. [DOI: 10.1177/0269215515579286] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 03/07/2015] [Indexed: 11/16/2022]
Abstract
Objectives: To investigate the psychometric properties of the Musculoskeletal Function Assessment (MFA) and Short Musculoskeletal Function Assessment (SMFA). Data sources: A systematic search of the following databases was undertaken concerning psychometric evidence of the MFA and SMFA: PubMed, Embase, Scopus and Cinahl. References of retrieved articles were inspected for additional data. Review method: Articles evaluating the validity, reliability or responsiveness of the MFA or SMFA in patients with musculoskeletal disorders were included in this systematic review. The methodological quality of included articles was critically appraised and the psychometric data were extracted using standardized forms. An established set of criteria were used to synthetize the evidence in order to highlight the strengths and weaknesses of included questionnaires and the gaps in the literature. Results: Nine articles on MFA and 24 articles on SMFA met the inclusion criteria. The SMFA fulfilled 75% of the psychometric criteria analyzed, while the MFA fulfilled only 50%. MFA and SMFA have excellent content validity and relative reliability (weighted average intraclass correlation coefficient ⩾ 0.87), and are moderately to highly responsive (standardized response mean between 0.65 and 1.13). Absolute reliability and clinically important difference of both questionnaires need to be defined, while the construct validity of MFA still needs to be established. Conclusion: MFA and SMFA are reliable and responsive tools for monitoring the function of patients with various musculoskeletal disorders. Still, research is needed to justify their usage in a clinical setting.
Collapse
Affiliation(s)
- Jason Bouffard
- Université Laval, Rehabilitation Department, Quebec City, QC, Canada
- Center for Interdisciplinary Research on Rehabilitation and Social Integration (CIRRIS), Quebec City, QC, Canada
| | - Michaël Bertrand-Charette
- Université Laval, Rehabilitation Department, Quebec City, QC, Canada
- Center for Interdisciplinary Research on Rehabilitation and Social Integration (CIRRIS), Quebec City, QC, Canada
| | - Jean-Sébastien Roy
- Université Laval, Rehabilitation Department, Quebec City, QC, Canada
- Center for Interdisciplinary Research on Rehabilitation and Social Integration (CIRRIS), Quebec City, QC, Canada
| |
Collapse
|
25
|
Mora-Macías J, Reina-Romo E, Morgaz J, Domínguez J. In Vivo Gait Analysis During Bone Transport. Ann Biomed Eng 2015; 43:2090-100. [DOI: 10.1007/s10439-015-1262-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/17/2015] [Indexed: 10/24/2022]
|
26
|
Rosenbaum D, Macri F, Lupselo FS, Preis OC. Gait and function as tools for the assessment of fracture repair - the role of movement analysis for the assessment of fracture healing. Injury 2014; 45 Suppl 2:S39-43. [PMID: 24857027 DOI: 10.1016/j.injury.2014.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Assessment of gait and function might be as sensitive tool to monitor the progress of fracture healing. Currently available assessment tools for function use instrumented three dimensional gait analysis or pedobarography. The analysis is focused on gait or movement parameters and seeks to identify abnormalities or asymmetries between legs or arms. The additional inclusion of muscle function by electromyography can further elucidate functional performance and its temporal development. Alternative approaches abstain from directly assessing function in the laboratory but rather determine the amount of activities of daily living or the mere ability to perform defined tasks such as walking, stair climbing or running. Some of these methods have been applied to determine recovery after orthopaedic interventions including fracture repair. The combination of lab-based functional measurements and assessment of physical activities in daily live may offer a valuable level of information about the gait quality and quantity of individual patients which sheds light on functional limitations or rehabilitation of gait and mobility after a disease or injury and the respective conservative, medical or surgical treatment.
Collapse
Affiliation(s)
- Dieter Rosenbaum
- Institute for Experimental Musculoskeletal Medicine, Movement Analysis Lab, University Hospital Münster, Albert-Schweitzer-Campus 1, D3, 48129 Münster, Germany.
| | - Felipe Macri
- Department of Orthopaedics and Traumatology, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil
| | - Fernando Silva Lupselo
- Department of Orthopaedics and Traumatology, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil
| | - Osvaldo Cristiano Preis
- Department of Orthopaedics and Traumatology, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil
| |
Collapse
|