Asymmetry of Gait After Free Flap Reconstruction of Severe Tibial Fractures with Extensive Soft-Tissue Damage (original) (raw)
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Efficiency of gait measurement after complex foot trauma
Foot and Ankle Surgery, 1996
Four different gait analysis techniques (three-dimensional kinematic analysis, two force plates, dynamic electromyography (EMG), dynamic analysis of plantar pressure distribution) were employed in a study on 10 normal subjects and 12 patients after treatment of displaced calcaneal fractures. The aim was to evaluate each method for accuracy of measurement of the severity of functional impairment. Analysis of ankle joint kinematics revealed that the loss of motion after trauma at the subtalar joint (range of motion after injury 2.9 _+ 2.0 °, normal subjects 7.5 + 2.6 °) was compensated by an increased inward rotation of the foot. If the foot adduction mechanism did not suffice to prevent lateralization of the resultant force, additional inverting or adducting mechanisms (at the ankle, knee, hip and the pelvic level) could be demonstrated. Generally, three-dimensional joint moments and the shank muscle activity pattern were changed at an insignificant level. Force plate data and the analysis of plantar pressure distribution allowed us to assess gait with an accuracy of 83%. For evaluation of dynamic joint motion at the ankle level or above, classical kinetic-kinematic studies are indispensable but, as the kinetics and kinematics at the examined joint levels are highly complex, they can hardly be used to formulate a simple and reliable measure of gait. As the ground reaction force and the plantar impulse distribution as assessed by dynamic pedography represent the net sum of the effects of both the primary gait disturbance and the existing compensation mechanisms, these methods can easily be used for verification and quantification of gait disturbance with an acceptable cost/effectiveness ratio.
Gait Symmetry and Walking Speed Analysis Following Lower-Extremity Trauma
Physical Therapy, 2006
Background and Purpose. Gait has been shown to be a major determining factor of function following limb-salvage surgery. However, little is known regarding the measures associated with gait recovery for this patient population. The purpose of this study was to identify clinical measures associated with impaired walking speed and gait asymmetry in patients with lowerextremity reconstruction. Subjects. Study subjects were 381 patients from the Lower Extremity Assessment Project (LEAP) who had undergone reconstruction following severe lower-extremity trauma. Methods. The LEAP study was a longitudinal study of outcomes following lower-extremity reconstruction. The present study used 24-month clinical follow-up data. A combined outcome measure of reduced walking speed and gait deviation was chosen to provide a comprehensive measure of impaired physical mobility. Results. The most significant clinical factors associated with decreased walking speed and gait deviation were impaired ankle plantar-flexion range of motion, knee flexion strength, and a nonreciprocal stair-climbing pattern. Discussion and Conclusion. The findings provide clinicians with specific clinical measures associated with functional recovery in patients with lower-limb reconstruction. These measures, in turn, can be considered to inform treatment decision making and to prioritize interventions. [Archer KR, Castillo RC, MacKenzie EJ, Bosse MJ; LEAP Study Group. Gait symmetry and walking speed analysis following lower-extremity trauma.
Walking impairments after severe tibia plateau fractures. A gait pattern analysis
Journal of Orthopaedic Science, 2019
Tibia plateau fractures are severe knee injuries which have a great impact on the patients' lives, but in what extend is not clear yet in the literature. The purpose of this study was to investigate the short-term gait alternations after severe tibia plateau fractures treated with circular Ilizarov frame. Materials & methods: Gait pattern evaluation was performed to patients who were treated with circular Ilizarov frame after severe tibia plateau fractures (Schatzker IV-VI), three to six months after the frame removal. Gait evaluation performed by using a force plate in a walking platform at self selected speeds. Data collected from two walking tasks for each limb. Demographic, clinical, radiological and quality of life questionnaire (SF-12v2) and COST data were also collected. Results: The gait pattern of sixteen patients (aged 48.8 ± 13.3 years), following treatment with circular Ilizarov frame for severe tibia plateau fractures (Schatzker IV-VI) was analysed. The tests were performed at an average of 10.4 months after the initial treatment. SF-12v2 Mental scores have returned to normal (mean 55.8 ± 11.9) but physical scores remained impaired (mean 40.6 ± 11.3). COST scores reached average levels (mean 54.1 ± 19.8). A one-way repeated measures ANOVA was conducted to compare the GRFs and gait timing data of the affected limb with the normal one. Single limb support interval was significantly reduced to the affected limb (p < 0.001) and terminal stance phase was prolonged for the normal limb (p ¼ 0.05). The rest of the GRF and gait timing data did not reach significant differences. Conclusions: During the early stages of rehabilitation following severe tibia plateau fractures treated with circular Ilizarov frame, the gait pattern returns to normal curve morphology, but with reduced single limb support and terminal stance phases at the affected knee. Mental status returns to normal but symptoms and function remain impaired.
PM&R, 2014
Objective: To describe and compare the plantar pressures, temporal foot roll-over, and ground reaction forces (GRFs) between both limbs of subjects with unilateral transfemoral amputation and with those of able-bodied participants during walking. We also verify the relevance of a force plate and a pressure plate to discriminate changes in gait parameters of subjects with limb loss. Design: Cross-sectional study. Setting: Biomechanics laboratory. Subjects: A total of 14 subjects with unilateral transfemoral amputation and 21 ablebodied participants. Methods: We used a force plate and a pressure plate to assess biomechanical gait parameters while the participants were walking at their self-selected gait speed. Main Outcome Measurements: We measured plantar pressure peaks in 6 foot regions and the instant of their occurrence (temporal foot roll-over); and GRF peaks and impulses of anterior-posterior (braking and propulsive phases), medial-lateral, and vertical (load acceptance and thrust phases) components. Results: The thrust, braking, and propulsive peaks, and the braking and propulsive impulses, were statistically significantly lower in the amputated limb than in the sound limb (P < .05) and in able-bodied participants (P < .05). In the amputated limb, we observed higher pressure peaks in the lateral rearfoot and medial and lateral midfoot, and lower values in the forefoot regions compared to those in the other groups (P < .05). The temporal foot roll-over showed statistically significant differences among the groups (P < .05). Conclusions: The plantar pressures, temporal foot roll-over, and GRFs in subjects with unilateral transfemoral amputation showed an asymmetric gait pattern, and different values were observed in both of their lower limbs as compared with those of able-bodied subjects during walking. The force plate and pressure plate were able to determine differences between participants in gait pattern, suggesting that both plantar pressure and GRF analyses are useful tools for gait assessment in individuals with unilateral transfemoral amputation. Because of the convenience of pressure plates, their use in the clinical context for prosthetic management appears relevant to guide the rehabilitation of subjects with lower limb amputation.
Gait & Posture, 2021
Background: The goal of postoperative tibial plateau fracture (TPF) management is to ensure surgical fixation is maintained while returning patients to normal function as soon as possible, allowing patients to resume their normal activities of daily living. The aim of this study was to investigate longitudinal changes in lower limb joint kinematics following TPF and determine how these kinematics relate to self-reported function. Methods: Patients presenting with a TPF were recruited (n = 18) and undertook gait analysis at six postoperative time points (two weeks, six weeks, three months, six months, one and two years). Lower limb joint kinematics were assessed at each time point based on gait data. Statistical parametric mapping (SPM) was undertaken to investigate the change in joint kinematic traces with time. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was assessed at each time point to obtain self-reported outcomes. A healthy reference was also analyzed and used for qualitative comparison of joint kinematics. Results and significance: Knee kinematics showed improvements with time, however only minor changes were noted after six weeks at the hip, and six months at the knee and ankle relative to two weeks postoperative. SPM identified significant improvements with time in hip (p < 0.001) and knee (p = 0.003) flexion. No significant changes were observed with time at the ankle however, when compared to the healthy reference, participants showed reduced plantarflexion at two years. Lower limb joint ROM showed significant weak to moderate correlation with the ADL sub-scale of the KOOS (hip r = 0.442, knee r = 0.303, ankle r = 0.367). The lack of significant changes with time and overall reduced plantarflexion at the ankle potentially reduces propulsive capacity during gait up to two years postoperative. In this study, we see a deficiency in joint kinematics in TPF patients up to two years when compared to a healthy reference, especially at the ankle.
Gait and electromyographic analysis of patients recovering after limb-saving surgery
Clinical Biomechanics, 2000
Objective. Control of gait after limb-saving surgery. Design. Case series study. Background. At the moment little is known about adaptations in patients' gait after limb-saving surgery. Methods. Nineteen patients who underwent limb-saving surgery at least 1 yr earlier and 10 normal subjects were studied during treadmill walking. The main outcome measures were walking speed, step parameters and angular displacement of both legs and EMG of the biceps femoris, rectus femoris and medial gastrocnemius in the aected leg.
Return of functional mobility after an open tibial fracture
The bone & joint journal, 2015
The aim of this study was to quantify and characterise the return of functional mobility following open tibial fracture (OTF) using the Hamlyn Mobility Score (HMS). Twenty patients who had undergone post-traumatic lower limb reconstruction were followed up at 3month intervals for 1-year. An ear-worn motion sensor (e-AR, Imperial College London) was used to assess the performance of subjects during a short activity protocol. The HMS and its constituent kinematic features were calculated longitudinally, allowing mobility analysis throughout recovery as well as between subjects with varying severity of injury. Functional mobility of the cohort improved throughout the full follow-up period. Patients with more severe fractures appeared to recover at a slower rate, with Gustilo-1 (G1) completing the majority of their recovery within the first 3-months, G2 until 6-months, G3 patients until 9months. Gait analysis revealed walking quality continues to improve 12-months postoperatively, whereas walking capacity plateaus after 6-months. Late complications were detected where subject recovery trajectories deviated >0.5 SD below that of the cohort. This is the first objective, longitudinal assessment of functional recovery in the OTF cohort, providing multidimensional evidence which begins to clarify the differences in prognosis associated with fracture severity.