Westerveld, S. (Sanne) (2020) Monitoring gait quality in trauma patients with surgically treated lower extremity fractures. thesis, Human Movement Sciences.
Full text available on request.Abstract
Introduction: Analysing gait quality is described as a reliable method to monitor the recovery of patients after surgical fixation of lower extremity fractures. Gait quality can be evaluated using pressure distribution and gait line. More symmetrical gait is associated with better clinical outcomes, which is facilitated by loading the fracture. The current study investigates whether patients treated according to a permissive weight bearing (PWB) protocol show an improved gait pattern compared to patients that adhere to a restricted weight bearing (RWB) protocol and reach full weight bearing (FWB) earlier. An additional aim is to explore differences in gait adaptations between the different fracture locations. Methods: From six hospitals, 106 trauma patients with a surgically treated intra-/peri-articular fracture of the lower extremities were included and equally divided over the PWB and RWB group. Measurements with Moticon sensor insoles started immediately after surgery and continued, every two weeks, until a patient reached full weight bearing and at least until and including week twelve. Asymmetry coefficients were calculated to compare pressure distribution and gait line progression between patients and groups. Results: An ANCOVA controlling for age, showed a significant shorter time to FWB for the PWB group, F(1,101) = 138.2, p<.001. In week 4-6, 8-10 and 10-12, patients treated according to PWB showed less asymmetry of pressure distribution (t(78) = 4.47, p < .001; t(80) = 3.23, p = .002; t(80) = 2.78, p = .007). Repeated measures ANOVA showed no significant effect of measurement week gait line asymmetry coefficients within and between groups. The mean start and end points of the gait line were different for different fractures. Conclusion: The current study confirms that patients who are treated according to a permissive weight bearing protocol reach full weight bearing earlier than patients that adhere to a restricted weight bearing protocol. In week 4-6, 8-10 and 10-12, analysis of pressure distribution shows less asymmetry in the PWB group compared to the RWB group, indicating a more physiological gait pattern in the PWB group. However, there are no substantial differences found in gait line asymmetry between the two groups. Furthermore, analysis of gait lines per fracture location suggests that there are different typical gait line progressions for different fractures. Keywords: lower extremity fractures, gait symmetry, insole measurements, pressure distribution, gait line
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Keeken, dr. H.G. van and Maduro, C.V. |
| Faculty: | Medical Sciences |
| Date Deposited: | 20 May 2022 11:39 |
| Last Modified: | 20 May 2022 11:39 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3388 |
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