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Review
. 2023 Feb 15;10(2):255.
doi: 10.3390/bioengineering10020255.

Gait Analysis to Monitor Fracture Healing of the Lower Leg

Elke Warmerdam  1 , Marcel Orth  2 , Tim Pohlemann  2 , Bergita Ganse  1   2
Affiliations
Review

Gait Analysis to Monitor Fracture Healing of the Lower Leg

Elke Warmerdam et al. Bioengineering (Basel). .

Abstract

Fracture healing is typically monitored by infrequent radiographs. Radiographs come at the cost of radiation exposure and reflect fracture healing with a time lag due to delayed fracture mineralization following increases in stiffness. Since union problems frequently occur after fractures, better and timelier methods to monitor the healing process are required. In this review, we provide an overview of the changes in gait parameters following lower leg fractures to investigate whether gait analysis can be used to monitor fracture healing. Studies assessing gait after lower leg fractures that were treated either surgically or conservatively were included. Spatiotemporal gait parameters, kinematics, kinetics, and pedography showed improvements in the gait pattern throughout the healing process of lower leg fractures. Especially gait speed and asymmetry measures have a high potential to monitor fracture healing. Pedographic measurements showed differences in gait between patients with and without union. No literature was available for other gait measures, but it is expected that further parameters reflect progress in bone healing. In conclusion, gait analysis seems to be a valuable tool for monitoring the healing process and predicting the occurrence of non-union of lower leg fractures.

Keywords: implant; malunion; motion capture; movement analysis; non-union; rehabilitation; tibial fracture; trauma; wearables.

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Conflict of interest statement

T.P. is president elect and board member of the AO Foundation, Switzerland, and extended board member of the German Society of Orthopedic Trauma Surgery (DGU), the German Society of Orthopedic Surgery and Traumatology (DGOU), and the German Society of Surgery (DGCH). T.P. is also the speaker of the medical advisory board of the German Ministry of Defense. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Fracture locations of the lower leg. The fibula can be involved in both distal tibial fractures as well as malleolar fractures. The distal tibia may also be involved in malleolar fractures. The AO classification numbers associated with the fracture locations are provided between brackets.
Figure 2
Figure 2
Overview of data from studies with different type of lower leg fractures [7,8,29,30,31,35,37,38,39,42,43,44,45,46,48]. (a) Gait speed after a lower leg fracture. (b). Step length after a lower leg fracture of the injured side. The type of lower leg fracture is indicated by the shape of the marker.
Figure 2
Figure 2
Overview of data from studies with different type of lower leg fractures [7,8,29,30,31,35,37,38,39,42,43,44,45,46,48]. (a) Gait speed after a lower leg fracture. (b). Step length after a lower leg fracture of the injured side. The type of lower leg fracture is indicated by the shape of the marker.
Figure 3
Figure 3
Linear relationship between gait speed and step length after a lower leg fracture [7,8,29,31,35,37,38,39,42,44,45,48]. Data pooled from studies with lower leg fractures, the correlation is weighted based on the number of participants per study.
Figure 4
Figure 4
The expected changes in gait-related parameters after surgery in union and non-union of lower leg fractures. An increase indicates an improvement. The shaded blue indicates the expected range for non-union fractures.
Figure 5
Figure 5
(a) Pie chart indicating how many studies performed a certain number of measurements. (b) Pie chart indicating how many patients from the studies combined were measured a certain number of times.
See this image and copyright information in PMC

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