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Observational Study
. 2022 Oct;48(5):4053-4060.
doi: 10.1007/s00068-022-01933-y. Epub 2022 Mar 13.

The grade of instability in fragility fractures of the pelvis correlates with impaired early mobilization

Leon Marcel Faust  1 , Alexander Martin Keppler  1 , Eduardo Suero  1 , Johannes Gleich  1 , Leonard Lisitano  2 , Wolfgang Böcker  1 , Carl Neuerburg  1 , Daniel Pfeufer  3
Affiliations
Observational Study

The grade of instability in fragility fractures of the pelvis correlates with impaired early mobilization

Leon Marcel Faust et al. Eur J Trauma Emerg Surg. 2022 Oct.

Abstract

Purpose: This study aimed to investigate whether gait patterns of patients with fragility fractures of the pelvis (FFP) comply with the grade of fracture instability, defined by radiological patterns.

Patients and methods: This prospective, single-center, observational study included 39 patients with an FFP. Gait analysis was performed with a wearable insole force sensor (Loadsol® by Novel, Munich, Germany) 4-7 days after admission. Patients were divided in two groups: Group A included FFP type 1 fractures, which affect the anterior pelvic ring only, Group B contained FFP type 2-4 fractures with an involvement of the posterior pelvic ring. Primary outcome parameter was the FTI ratio (force-time integral (N*s)).

Results: The mean age was 85.08 years (SD ± 6.45), 94.9% (37/39) of the patients were female. The most common fracture type was an FFP 2b (64.1%, 25/39). Group A showed a significantly higher FTI ratio (45.12%, SD ± 4.19%) than Group B (38.45%, SD ± 5.97%, p = 0.002). Further, a significant correlation of the FTI ratio and the average (r = 0.570, p < 0.001) and maximum (r = 0.394, p = 0.013) peak force was observed.

Conclusion: The gait pattern of patients with an FFP type 2-4 was more imbalanced than of patients with an FFP type 1 fracture. These findings match with the radiological classification of FFP, which indicates higher instability, when the posterior pelvis is affected. Gait analysis might offer earlier functional diagnostics and may accelerate the treatment decision with shorter periods of immobility in future. Especially in cross-border cases, early gait analysis could be beneficial to clarify the indication for or against surgery.

Keywords: Fragility fractures of the pelvis; Gait analysis; Mobility; Orthogeriatrics; Pelvic fracture; Wearables.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to declare.

Figures

Fig. 1
Fig. 1
Patient selection process with reasons for primary exclusion and withdrawal in the further course of the study
Fig. 2
Fig. 2
a The Loadsol® insole is fitted into the patients’ shoes. b Illustration of the measurement process. The patient is mobilized with a walker and a member of the research team is collecting the gait data using a tablet
Fig. 3
Fig. 3
Visualization of the force–time curve recorded during gait analysis. Three exemplary steps are depicted for both feet, (limb 1: blue, limb 2: gray). Y-axis: force in newton, X-axis: time in seconds. The legend shows the three main parameters: force–time integral (FTI), maximum peak force (Max. Pf.) and average peak force (Avg. Pf.) and how they are marked in the graph
Fig. 4
Fig. 4
Box plot of Group A (FFP 1) and Group B (FFP 2–4), p = 0.002. The FTI ratio (%) is shown on the Y-axis
See this image and copyright information in PMC

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