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

Longitudinal changes in lower limb muscle activity during walking and stair climbing with full weight bearing in postoperative Trimalleolar fracture patients

Patients after ankle fracture are instructed to avoid weight bearing for several weeks. This study aimed to determine changes in lower limb muscle activity during both walking and stair climbing at 1 and 2 months after resuming weight bearing. The study population consisted of 10 patients who had undergone open osteosynthesis for unilateral trimalleolar fracture. Lower limb muscle activity was measured using surface electromyography. When it became possible to walk without the aid of assistive devices, we measured the lower limb muscle activity during walking and stair climbing. As a result of multiple comparisons, lower limb muscle activity during walking was significantly reduced when comparing the baseline and the measurement taken 2 months later. Both lower limb muscle activity when ascending and descending stairs was significantly reduced when comparing the 1 and 2 months later. The study compared lower limb muscle activity during walking and stair climbing in postoperative patients with trimalleolar fractures, immediately after resumption of full weight bearing and at 1 and 2 months' follow-up. The results showed that the degree of recovery varied between muscles when comparing baseline and 1 month later for both walking and stair climbing, but all muscle activities were reduced when compared to 2 months later.

Ankle Fracture Gait Training Through Musical Feedback: case study

Background

Trimalleolar ankle fractures often result in mobility and gait impairments. To date, there is little consensus on the rehabilitation regimen. Biofeedback is an emerging approach that improves gait in different populations; here, we utilized novel customized musical biofeedback to retrain gait following trimalleolar ankle fracture.

Case Presentation

A 56-year-old male sustained a right trimalleolar ankle fracture and underwent surgical fixation, followed by immobilization, progressive weight bearing, and a regular physical therapy regimen. Additional gait training sessions were provided with musical feedback from pressure-sensing insoles to provide accurate cues to encourage medialized load pressure and prevent avoidance behavior.

Outcome and Follow-up

Mobility, functionality, stance phase, stride length, total force distribution, and plantar pressure improved after training.

Discussion

This is the first study on gait training after ankle fracture using customized pressure-based biofeedback with music to normalize plantar pressure and push-off phase.

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

Walking is an indispensable mode of transportation for human survival. Gait is a characteristic of walking. In the clinic, patients with different diseases exhibit different gait characteristics. Gait analysis describes the specific situation of human gait abnormalities by observing and studying the kinematics and dynamics of limbs and joints during human walking and depicting the corresponding geometric curves and values. In foot and ankle diseases, gait analysis can evaluate the degree and nature of gait abnormalities in patients and provide an important basis for the diagnosis of patients' diseases, the correction of abnormal gait and related treatment methods. This article reviews the relevant literature, expounds on the clinical consensus on gait, and summarizes the gait characteristics of patients with common ankle and foot diseases. Starting from the gait characteristics of individuals with different diseases, we hope to provide support and reference for the diagnosis, treatment and rehabilitation of clinically related diseases.

Comprehensive Physiotherapy Protocol in Post-operative Case of Trimalleolar Fracture: A Case Report

A common ankle fracture that can have major consequences and expensive medical bills is the trimalleolar fracture. The trimalleolar fracture is the least frequent type of ankle fracture. The number of afflicted malleoli, the kind of fracture of the lateral and medial malleolus and the congruence of the ankle joint were all examined in detail for the trimalleolar ankle fracture. This type of fracture is brought on by high-energy trauma. In this case report, we describe a 56-year-old female patient who was involved in a road traffic accident. After being taken to the hospital for further examination, her ankle fracture was determined to be a trimalleolar one. She had an internal fixation with canulated cancellous screws and nails for open reduction. For such patients, we designed a physiotherapy course based on early rehabilitation and sensorimotor retraining to help with proprioception training, gait training and lower-limb muscular strength training. The lower limb's strength and range of motion were improved with the treatment. The outcomes used were the numerical pain rating scale (NPRS), functional independence measure (FIM), lower-extremity functional scale (LEFS), range of motion (ROM), gait parameters and manual muscle testing (MMT).

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

Recovery after ankle fracture surgery can be slow and even present functional deficits in the long term, so it is essential to monitor the rehabilitation process objectively and detect which parameters are recovered earlier or later. The aim of this study was (1) to evaluate dynamic plantar pressure and functional status in patients with bimalleolar ankle fracture 6 and 12 months after surgery, and (2) to study their degree of correlation with previously collected clinical variables. Twenty-two subjects with bimalleolar ankle fractures and eleven healthy subjects were included in the study. Data collection was performed at 6 and 12 months after surgery and included clinical measurements (ankle dorsiflexion range of motion and bimalleolar/calf circumference), functional scales (AOFAS and OMAS), and dynamic plantar pressure analysis. The main results found in plantar pressure were a lower mean/peak plantar pressure, as well as a lower contact time at 6 and 12 months with respect to the healthy leg and control group and only the control group, respectively (effect size 0.63 ≤ d ≤ 0.97). Furthermore, in the ankle fracture group there is a moderate negative correlation (-0.435 ≤ r ≤ 0.674) between plantar pressures (average and peak) with bimalleolar and calf circumference. The AOFAS and OMAS scale scores increased at 12 months to 84.4 and 80.0 points, respectively. Despite the evident improvement one year after surgery, data collected using the pressure platform and functional scales suggest that recovery is not yet complete.

Effects of age, body height, body weight, body mass index and handgrip strength on the trajectory of the plantar pressure stance-phase curve of the gait cycle

The analysis of gait patterns and plantar pressure distributions via insoles is increasingly used to monitor patients and treatment progress, such as recovery after surgeries. Despite the popularity of pedography, also known as baropodography, characteristic effects of anthropometric and other individual parameters on the trajectory of the stance phase curve of the gait cycle have not been previously reported. We hypothesized characteristic changes of age, body height, body weight, body mass index and handgrip strength on the plantar pressure curve trajectory during gait in healthy participants. Thirty-seven healthy women and men with an average age of 43.65 ± 17.59 years were fitted with Moticon OpenGO insoles equipped with 16 pressure sensors each. Data were recorded at a frequency of 100 Hz during walking at 4 km/h on a level treadmill for 1 minute. Data were processed via a custom-made step detection algorithm. The loading and unloading slopes as well as force extrema-based parameters were computed and characteristic correlations with the targeted parameters were identified via multiple linear regression analysis. Age showed a negative correlation with the mean loading slope. Body height correlated with Fmean_load and the loading slope. Body weight and the body mass index correlated with all analyzed parameters, except the loading slope. In addition, handgrip strength correlated with changes in the second half of the stance phase and did not affect the first half, which is likely due to stronger kick-off. However, only up to 46% of the variability can be explained by age, body weight, height, body mass index and hand grip strength. Thus, further factors must affect the trajectory of the gait cycle curve that were not considered in the present analysis. In conclusion, all analyzed measures affect the trajectory of the stance phase curve. When analyzing insole data, it might be useful to correct for the factors that were identified by using the regression coefficients presented in this paper.