Recovery of gait and function during the first six months after tibial shaft fractures

Kröger, Inga; Müßig, Janina Anna; Brand, Andreas; Pätzold, Robert; Wackerle, Hannes; Klöpfer-Krämer, Isabella; Augat, Peter

doi:10.1016/j.gaitpost.2021.09.199

Cited by 5 publications

(19 citation statements)

References 26 publications

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“…However, for individualized aftercare the herein introduced monitoring of the walking speed in combination with changes of the shape of the gait cycle curve in consideration of potential weight-bearing restrictions, as well as potentially other kinetic and kinematic parameters may be helpful novel tools for clinical follow-up controls of bone healing. In fact, this is in line with previous studies analyzing the relevance of gait patterns on bone healing in an experimental setting ( Seebeck et al, 2005 ; Kröger et al, 2022 ). Also, it has been demonstrated that the initial phase of healing is sensitive to mechanical conditions and influences the course of healing ( Klein et al, 2003 ).…”

Section: Discussionsupporting

confidence: 92%

Simulation-based prediction of bone healing and treatment recommendations for lower leg fractures: Effects of motion, weight-bearing and fibular mechanics

Orth

Ganse²,

Andres³

et al. 2023

Front. Bioeng. Biotechnol.

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Despite recent experimental and clinical progress in the treatment of tibial and fibular fractures, in clinical practice rates of delayed bone healing and non-union remain high. The aim of this study was to simulate and compare different mechanical conditions after lower leg fractures to assess the effects of postoperative motion, weight-bearing restrictions and fibular mechanics on the strain distribution and the clinical course. Based on the computed tomography (CT) data set of a real clinical case with a distal diaphyseal tibial fracture, a proximal and a distal fibular fracture, finite element simulations were run. Early postoperative motion data, recorded via an inertial measuring unit system and pressure insoles were recorded and processed to study strain. The simulations were used to compute interfragmentary strain and the von Mises stress distribution of the intramedullary nail for different treatments of the fibula, as well as several walking velocities (1.0 km/h; 1.5 km/h; 2.0 km/h) and levels of weight-bearing restriction. The simulation of the real treatment was compared to the clinical course. The results show that a high postoperative walking speed was associated with higher loads in the fracture zone. In addition, a larger number of areas in the fracture gap with forces that exceeded beneficial mechanical properties longer was observed. Moreover, the simulations showed that surgical treatment of the distal fibular fracture had an impact on the healing course, whereas the proximal fibular fracture barely mattered. Weight-bearing restrictions were beneficial in reducing excessive mechanical conditions, while it is known that it is difficult for patients to adhere to partial weight-bearing recommendations. In conclusion, it is likely that motion, weight bearing and fibular mechanics influence the biomechanical milieu in the fracture gap. Simulations may improve decisions on the choice and location of surgical implants, as well as give recommendations for loading in the postoperative course of the individual patient.

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Section: Discussionsupporting

confidence: 92%

Simulation-based prediction of bone healing and treatment recommendations for lower leg fractures: Effects of motion, weight-bearing and fibular mechanics

Orth

Ganse²,

Andres³

et al. 2023

Front. Bioeng. Biotechnol.

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“…Twelve months after surgery, one study with tibial plateau fractures and another study with tibial shaft fractures did not find significant differences in gait speed anymore compared to healthy controls [8,37]. Multiple other studies that presented cross-sectional data ranging from about two months to five years after surgery or injury from patients with all types of lower leg fractures showed that gait speed and step length remained significantly shorter in patients compared to controls [7,[29][30][31]35,39,[42][43][44].…”

Section: Pacementioning

confidence: 92%

“…Spatiotemporal gait parameters are frequently measured to determine gait deviations. There are several systems available that can be used to extract spatiotemporal gait parameters, such as 3D optical motion capture systems [35,43], electronic walkways (pressure-sensitive mats) [8,44], and inertial measurement units (IMUs) [27]. The spatiotemporal gait parameters can be divided in different gait domains, i.e., pace, rhythm, variability, and asymmetry [49,50].…”

Section: Methodsmentioning

confidence: 99%

“…three of these studies also measured step length throughout the healing process after p imal tibial, tibial shaft and malleolar fractures (Figure 2) [35,37,45,46]. These stu showed significant increases in gait speed and step length of the injured side over ti Twelve months after surgery, one study with tibial plateau fractures and another st with tibial shaft fractures did not find significant differences in gait speed anymore c pared to healthy controls [8,37].…”

Section: Variabilitymentioning

confidence: 97%

“…The pace-related gait domain consists of the parameters gait speed and step length. In the context of lower leg fractures, we found four studies that measured gait speed and three of these studies also measured step length throughout the healing process after proximal tibial, tibial shaft and malleolar fractures (Figure 2) [35,37,45,46]. These studies showed significant increases in gait speed and step length of the injured side over time.…”

Section: Pacementioning

confidence: 99%

See 2 more Smart Citations

Gait Analysis to Monitor Fracture Healing of the Lower Leg

et al. 2023

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Fracture healing is typically monitored by infrequent radiographs. Radiographs come at the cost of radiation exposure and reflect fracture healing with a time lag due to delayed fracture mineralization following increases in stiffness. Since union problems frequently occur after fractures, better and timelier methods to monitor the healing process are required. In this review, we provide an overview of the changes in gait parameters following lower leg fractures to investigate whether gait analysis can be used to monitor fracture healing. Studies assessing gait after lower leg fractures that were treated either surgically or conservatively were included. Spatiotemporal gait parameters, kinematics, kinetics, and pedography showed improvements in the gait pattern throughout the healing process of lower leg fractures. Especially gait speed and asymmetry measures have a high potential to monitor fracture healing. Pedographic measurements showed differences in gait between patients with and without union. No literature was available for other gait measures, but it is expected that further parameters reflect progress in bone healing. In conclusion, gait analysis seems to be a valuable tool for monitoring the healing process and predicting the occurrence of non-union of lower leg fractures.

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Improved weight bearing during gait at 6 weeks post-surgery with an angle stable locking system after distal tibial fracture

Agres,

Alves,

Höntzsch

et al. 2024

Gait & Posture

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Recovery of gait and function during the first six months after tibial shaft fractures

Cited by 5 publications

References 26 publications

Simulation-based prediction of bone healing and treatment recommendations for lower leg fractures: Effects of motion, weight-bearing and fibular mechanics

Simulation-based prediction of bone healing and treatment recommendations for lower leg fractures: Effects of motion, weight-bearing and fibular mechanics

Gait Analysis to Monitor Fracture Healing of the Lower Leg

Improved weight bearing during gait at 6 weeks post-surgery with an angle stable locking system after distal tibial fracture

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