Highlights
- •Tibial plateau fractures are associated with accelerated knee joint degeneration.
- •The study investigates correlation between fracture characteristics and gait parameters.
- •Higher number of fracture fragments negatively correlates with velocity and cadence.
- •Affected limbs had shorter step length and single-limb support times.
Abstract
Background
Functional scores and radiographs are often used to assess function and predict development
of osteoarthritis in patients with multi-fragmentary tibial plateau fractures (TPFs).
Locomotion, which is the primary goal of fracture treatment, is rarely assessed. The
objective of this study was to assess functional ability of patients after TPF fixation
using spatio-temporal gait analysis (STGA), and to compare STGA variables with self-reported
functional scores and preoperative fracture characteristics.
Methods
Preoperative CT scans of 21 patients with complete articular multi-fragmentary TPFs
were evaluated for number of fragments, maximum gap between the fragments and maximum
articular depression. All patients underwent STGA (velocity, cadence, step length
of the affected and the unaffected leg, single-limb support by the affected and the
unaffected leg, and double-leg support) and filled the Knee Society Score and the
Short Form-12 questionnaires on average 3 years (SD = 1.56, range, 2–5.8) post-injury.
Findings
Step length and single-limb support time of the affected leg were shorter compared
to the unaffected leg (p = 0.02 and p = 0.007, respectively). Number of fracture fragments correlated with cadence (R = −0.461, p = 0.04) and velocity (R = −0.447, p = 0.04).
Interpretation
Given that both higher fracture comminution and deformity on the one hand and the
above gait parameter alterations on the other hand are associated with knee osteoarthritis,
STGA may be used for routine postoperative evaluation of patients after TPF fixation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical BiomechanicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Failure of fixation of tibial plateau fractures.J. Orthop. Trauma. 2002; 16: 323-329
- Psychometric properties of the SF-12 (Hebrew version) in a primary care population in Israel.Med. Care. 2002; 40: 918-928https://doi.org/10.1097/01.MLR.0000027359.33761.FA
- Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels.J. Biomech. 2008; 41: 868-876https://doi.org/10.1016/j.jbiomech.2007.10.016
Baker, R., n.d. Measuring Walking: A Handbook of Clinical Gait Analysis.
- The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis.Ann. Rheum. Dis. 2007; 66: 1271-1275https://doi.org/10.1136/ard.2006.062927
- Gait characteristics before hardware removal in patients operated upon for tibial plateau fractures.Int. Orthop. 2015; 39: 1411-1415https://doi.org/10.1007/s00264-015-2691-0
- Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee.Knee Surg. Sports Traumatol. Arthrosc. 2015; 23: 1317-1323https://doi.org/10.1007/s00167-013-2828-x
- Novel classification of knee osteoarthritis severity based on spatiotemporal gait analysis.Osteoarthr. Cartil. 2014; 22: 457-463https://doi.org/10.1016/j.joca.2013.12.015
- Asymmetry in gait pattern following bicondylar tibial plateau fractures—a prospective one-year cohort study.Injury. 2017; 48: 1657-1661https://doi.org/10.1016/j.injury.2017.04.045
- WSIAT | Symptoms in the Opposite or Uninjured Leg.WWW Document, 2005 (accessed 3.17.18)
- Rationale of the knee society clinical rating system.Clin. Orthop. Relat. Res. 1989; : 13-14
- Sports activity after surgical treatment of intra-articular tibial plateau fractures in skiers.Am. J. Sports Med. 2013; 41: 1340-1347https://doi.org/10.1177/0363546513489524
- Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 125 cases.Int. Orthop. 2010; 34: 565-570https://doi.org/10.1007/s00264-009-0790-5
- Gait analysis following medial opening-wedge high tibial osteotomy.Knee Surgery, Sport. Traumatol. Arthrosc. 2018; 26: 1838-1844https://doi.org/10.1007/s00167-017-4421-1
- Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results.J. Orthop. Trauma. 2007; 21: 5-10https://doi.org/10.1097/BOT.0b013e31802c5b51
- The relationship between peak knee extension at heel-strike of walking and the location of thickest femoral cartilage in ACL reconstructed and healthy contralateral knees.J. Biomech. 2013; 46: 849-854https://doi.org/10.1016/j.jbiomech.2012.12.026
- The long-term functional outcome of operatively treated tibial plateau fractures.J. Orthop. Trauma. 2001; 15: 312-320
- Does knee alignment influence gait in patients with severe knee osteoarthritis?.Clin. Biomech. 2013; 28: 34-39https://doi.org/10.1016/j.clinbiomech.2012.09.004
- Results following operative treatment of tibial plateau fractures.J. Knee Surg. 2012; 26: 161-166https://doi.org/10.1055/s-0032-1324807
- A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.Med. Care. 1996; 34: 220-233
- Gait characteristics and quality of life perception of patients following tibial plateau fracture.Arch. Orthop. Trauma Surg. 2015; 135: 1541-1546
- Risk of total knee arthroplasty after operatively treated tibial plateau fracture.J. Bone Jt. Surgery-American. 2014; 96: 144-150https://doi.org/10.2106/JBJS.L.01691
- High-energy fractures of the tibial plateau.J. Bone Joint Surg. Am. 84–A. 2002; (Knee function after longer follow-up): 1541-1551
- Fractures.2nd ed. Lippincott Williams & Wilkins, Philadelphia2006 (.)
- Definitive fixation of tibial plateau fractures.Orthop. Clin. North Am. 2015; 46: 363-375https://doi.org/10.1016/j.ocl.2015.02.005
- Fractures of the tibial plateau.in: Ostrum R.F. Ricci W.M. Orthopaedic Knowledge Update, OKU 5. Trauma. American Academy of Orthopedic Surgeons, Rosemont, IL1996: 159-169
Article Info
Publication History
Published online: April 15, 2019
Accepted:
April 14,
2019
Received:
March 28,
2018
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
