gms | German Medical Science

Objectives: Non-union occurs in up to 14% of tibial fractures [1]. Radiographs only reflect fracture healing in intervals of several weeks and with a time lag due to delayed fracture mineralisation following increases in stiffness. It would be desirable to monitor progress in fracture healing in a timelier manner or even continuously to be able to intervene early in case of problems. The aim of this study was to compare insole-derived gait data from intermittent and continuous measurements throughout the healing process of tibial fractures.

Methods: In this ongoing study, 12 patients with tibial fractures have been included to date (5 tibial shaft fractures and 7 proximal tibial fractures). All of them received surgical treatment. Gait analysis was performed with pressure sensing insoles (Moticon OpenGo, Munich, Germany) containing 16 pressure sensors and an inertial measurement unit. Intermittent measurements were conducted in the hospital a few days after surgery and during outpatient visits. Continuous measurements were simultaneously performed during the daily life of the patients. Several gait parameters were calculated, such as the maximal vertical force per stance phase, the loading and unloading slope of the vertical force curve. A paired sample T-test was used to test the difference between the intermittent and the average of three days of continuous assessments around the day of the intermittent assessment.

Results and conclusion: Force data from three patients are presented in Figure 1 [Fig. 1]. Both, intermittent and continuous data showed increases in gait performance with successful healing and decreases in the patient who developed an infected non-union. No significant differences were found for maximal vertical force (p = .450) and loading (p = .273), and unloading slopes (p = .806) between intermittent and continuous measurements. More gait data were collected during continuous compared to intermittent assessments. These additional datapoints provided better insights in the healing process in between clinical visits.

Both, intermittent and continuous gait measures can be used to monitor tibial fracture healing. The continuous data collected during daily life provided additional information compared to the intermittent measurements. In particular, deteriorations in gait performance that may indicate healing problems can be detected earlier.