Gait analysis related to functional outcome in patients operated for ankle fractures

Abstract

Ankle fractures are among the most common lower limb fractures. Associations between postoperative radiographic results and clinical outcome have been found, but less is known about the relevant ankle biomechanics. This study analysed ankle kinematics, radiographic findings and patient-reported outcome measures (PROM) in patients treated for ankle fractures. The hypothesis was that patients after ankle fracture surgery had less flexion/extension in the ankle compared to healthy subjects and that fracture severity had significant influence on kinematics and patient satisfaction. Thirty-three patients (n=33 feet) operated for ankle fractures were recruited. Ankle kinematics were analysed using the Oxford Foot model, and results were compared with an age-matched healthy control group (11 patients, 20 feet). In addition, patients were divided by fracture (severity) classification and kinematic results were correlated with PROM and radiographic findings. Patients treated for ankle fracture showed lower walking speed (p<0.001) when asked to walk in preferred normal speed. When compared at equal speed, significantly less range of motion (ROM) between the hindfoot and tibia in the sagittal plane (flexion/extension) during loading and push-off phases (p=0.003 and p<0.001) was found in patients after ankle fractures compared to healthy subjects. Lowest ROM and poorest PROM results were found for patients with trimalleolar ankle fractures. There was a significant correlation between ROM (flexion/extension) during the push-off phase and SF-36 physical functioning (r =0.403, p=0.027) and SF-36 general health (r =0.473, p=0.008). Fracture severity was significantly correlated with flexion/extension ROM in the ankle during both loading and push-off phases (r =-0.382, p=0.005, and r =-0.568, p<0.001) and was also significantly correlated with PROM. This study found that patients with ankle fractures had significantly altered ankle kinematics compared to healthy subjects. The poorest results were found among patients with trimalleolar fractures. Weak to strong significant correlations were found between fracture severity, ankle kinematics and PROM. This article is protected by copyright. All rights reserved.

Short‐term results of gait analysis with the Heidelberg foot measurement method and functional outcome after operative treatment of ankle fractures

“…Previous studies already showed a restriction of clinical dorsiflexion and plantarflexion between the tibia and the hindfoot in the stance and swing phase in affected patients compared to healthy participants [ 1 , 7 , 25 ]. This is in line with our results of restricted movement in the tibio-talar joint.…”

“…Furthermore, we were able to show that these results are the same regardless of the foot model applied. While Wang et al [ 1 ] and van Hoeve et al [ 7 ] used the Oxford foot model or a modified version of it with just 3 segments for their examinations we used the HFMM. When comparing the results, one has to consider that the HFMM takes the independent movements of the tibio-talar and subtalar joint into account, while the Oxford foot model imagines these two just as a ball-and-socket joint.…”

“…For this purpose, a three-dimensional gait analysis can be used to collect objective information about the gait pattern. Furthermore, it can provide a more reliable predictor of patient-reported functional outcome [ 7 ].…”

Muscle Activation Profile During Perturbed Walking is Modulated According to Body State

“…Since there are no sEMG frequency analysis studies in walking with perturbations, the sample size was chosen to be comparable with sEMG frequency analysis studies during walking with no perturbations using similar outcomes (Nüesch et al, 2012;Roeder et al, 2020;Zhang et al, 2017). Exclusion criteria included conditions effecting balance control such as: age over 65 (L. Sturnieks et al, 2008); obesity (i.e., body mass index [kg/m 2 ] > 30) (Kopelman, 2000); orthopedic conditions affecting gait and balance (e.g., total knee replacement, total hip replacement, ankle sprain, limb fracture in the period of one year prior to participation (Jansen et al, 2013;Kubota et al, 2013Kubota et al, , 2012van Hoeve et al, 2019)); neurological diseases associated with loss of balance (e.g., multiple sclerosis, myelopathy); and conditions that could affect adherence and participation such as: cognitive loss or psychiatric conditions; untreated cardiac conditions (e.g., non-stable ischemic heart disease, congestive heart failure); and chronic obstructive pulmonary disease . The study protocol was approved by the Institutional Review Board of Sheba Medical Center).…”

Clinical study of intramedullary nailing fixation for the treatment of Danis-Weber B in lateral malleolus fracture

“…Ankle fractures are among the most common lower limb fractures and account for 9% of all fractures. 1 With the mechanism of injury varying from a simple fall to high-energy motor vehicle accidents, ankle fractures present a wide spectrum of fracture patterns. Ankle fractures are initially evaluated by physical examination and then by X-ray.…”