Clinical assessments and gait analysis for patients with Trimalleolar fractures in the early postoperative period

Abstract

Background Trimalleolar fracture is a common ankle fracture with serious complications and costly healthcare problem. Most studies used clinical assessments to evaluate the functional status of the patients. Although clinical assessments are valid, they are static and subjective. Dynamic, objective and precise evaluations such as gait analysis are needed. Ankle biomechanics studies on gait in patients with trimalleolar fractures are still rare. This study aimed to investigate the clinical outcomes and gait biomechanics in patients with trimalleolar fractures in the early postoperative period and compared to healthy controls. Methods This was a cross-sectional study. 12 patients with trimalleolar fractures were recruited, and 12 healthy people served as controls. All patients underwent clinical assessments: Olerud and Molander ankle score (OMAS), ankle swelling and passive range of motion (ROM) of ankle, and completed gait biomechanical analysis when weight-bearing was allowed: temporal-spatial parameters, plantar pressure distributions, and surface electromyography (sEMG). The control group only performed gait test. Results Patients had poor outcomes of clinical assessments in the short-term. During gait analysis, patients presented compromised gait patterns: shorter step length, larger step width, slower walking speed and shorter single support compared to healthy controls (P < 0.001), and patients showed asymmetrical gait. Symmetry index of step width and walking speed were mainly correlated with the difference of ankle inversion ROM between two sides (R = -0.750, P = 0.005; R = -0.700, P = 0.011). During walking, patients showed abnormal dynamic plantar pressure features (mainly in the hindfoot and forefoot regions), and the IEMG (integrated electromyography) of tibial anterior muscle (TA) and peroneal longus muscle (PL) were larger than healthy controls (P = 0.002, 0.050). Conclusions Patients with trimalleolar fractures showed physical impairments of the ankle, and presented altered gait parameters compared to healthy subjects in the short-term. The ankle stability of patients declined, and deficits in TA and PL muscle ability might contribute to it. Restoring complete muscle functions and improving passive ankle ROM are significant to promote the recovery of a normal gait pattern.

Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases

“…A study of dynamic plantar pressure changes at 6 and 12 months after bilateral ankle fracture surgery showed that AFG patients had lower plantar pressure (peak and mean) and longer contact time than did CG patients and that AFG patients had significantly lower e-cadence and gait speed than did the control group. Similarly, (Fernández-Gorgojo et al, 2023), Zhu et al (2022) reported similar results in a study of 12 subjects after trimalleolar fracture; i.e., abnormal changes in plantar pressure were mainly manifested in the forefoot and hindfoot regions. Compared with those in the healthy control group, the patients in the symptomatic group had shorter step lengths, larger step widths, slower walking speeds, shorter single supports and obvious asymmetry in gait; these authors believe that these differences might be related to functional impairment of the anterior tibial and peroneal longus muscle ability.…”

Analysis of Dynamic Plantar Pressure and Influence of Clinical-Functional Measures on Their Performance in Subjects with Bimalleolar Ankle Fracture at 6 and 12 Months Post-Surgery

“…Complementary to these functional scales, clinical parameters such as ankle dorsiflexion range of motion (ADF ROM), level of swelling, and muscle atrophy provide objective measures of clinical status at different stages of rehabilitation [18,26,27]. The recovery of these parameters after ankle surgery is critical and may play an important role in the full recovery of gait functionality [28] or balance [29].…”

A Rapid Detection of Parkinson’s Disease using Smart Insoles: A Statistical and Machine Learning Approach

“…However, recent advancements in technology have led to reliable, affordable, and compact sensors for gait analysis, enabling its application outside of a laboratory setting. Gait analysis has been applied in several sectors, including healthcare [2], security [3], and fitness [4] domains. According to the type of sensors involved and the methodologies chosen for assessing the gait, the available techniques can be classified into three main categories: image processing-based [5], floor sensors-based [6], and wearable sensors-based [7].…”