Assessment of Gait after Treatment of Tibial Nonunion with the Ilizarov Method

Abstract

Background: Tibial nonunion is a common bone union disorder leading to abnormal gait, and thus reducing quality of life in the social dimension.

Research question: The aim of our work was to comprehensively assess gait parameters of patients who had undergone Ilizarov treatment for tibial nonunion compared to a control group of healthy individuals.

Methods: This study evaluated patients treated for aseptic tibial nonunion with the Ilizarov method. 24 patients with a mean age of 55.0 years were included in the study. The control group consisted of 32 healthy volunteers with no significant medical history who were selected to match the gender and age of patients in the study group so that the groups were homogeneous. A Zebris Medical GmbH pedobarographic platform was used to assess the gait parameters.

Results: For all gait parameters examined, force forefoot max, force backfoot max, step length, stance phase, swing phase and step time, we observed statistically significant differences between the group that had undergone treatment and the control group. In the group of patients, statistically significant differences between the operated lower limb and the non-operated limb were only observed for the force forefoot max and step time parameters (p = 0.029 and p = 0.045, respectively). Patients presented a longer loading of the operated limb (0.720 s) than the non-operated limb (0.635 s). For the stride time, step cadence and gait velocity parameters, healthy subjects achieved much better results during locomotion, and these differences were statistically significant at p < 0.001.

Significance: Treatment of tibial nonunion with the Ilizarov method did not restore normal gait parameters in our group of patients. In fact, the gait parameters of patients were significantly worse than the healthy individuals in the control group. Furthermore, gait parameters following treatment were not symmetrical, and the dynamics of the musculoskeletal system remained impaired.

Keywords: Ilizarov method; gait; nonunion; pedobarography; tibia.

Figure 1

The gait parameters at a Zebris pedobarographic platform.

Figure 2

The comparison of force forefoot maximal load between healthy group and patients after treatment with the Ilizarov method. The boundary of the box closest to zero indicates the 25th percentile, a line within the box marks the median, and the boundary of the box farthest from zero indicates the 75th percentile. Whiskers above and below the box indicate the 90th and 10th percentiles. White boxes, healthy people; filled boxes, patients. OL, operated limb; NOL, non-operated limb.

Figure 3

The comparison of step length between healthy group and patients after treatment with the Ilizarov method. The boundary of the box closest to zero indicates the 25th percentile, a line within the box marks the median, and the boundary of the box farthest from zero indicates the 75th percentile. Whiskers above and below the box indicate the 90th and 10th percentiles. White boxes, healthy people; filled boxes, patients. OL, operated limb; NOL, non-operated limb.

Figure 4

The differences in gait parameters between healthy group and patients after treatment with the Ilizarov method. The boundary of the box closest to zero indicates the 25th percentile, a line within the box marks the median, and the boundary of the box farthest from zero indicates the 75th percentile. Whiskers above and below the box indicate the 90th and 10th percentiles.