In Vivo Foot Segmental Motion and Coupling Analysis during Midterm Follow-Up after the Open Reduction Internal Fixation of Trimalleolar Fractures

Author:

Hoekstra Harm12ORCID,Vinckier Olivier3,Staes Filip4ORCID,Berckmans Lisa4ORCID,Coninx Jolien4,Matricali Giovanni235ORCID,Wuite Sander235,Vanstraelen Eline6,Deschamps Kevin4678ORCID

Affiliation:

1. Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium

2. Department of Development and Regeneration, KU Leuven—University of Leuven, 3000 Leuven, Belgium

3. Department of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium

4. Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Tervuursevest 101, 3001 Leuven, Belgium

5. Institute for Orthopaedic Research and Training, KU Leuven—University of Leuven, Herestraat 49, 3000 Leuven, Belgium

6. Clinical Motion Analysis Laboratory, Campus Pellenberg, University Hospitals Leuven, Weligerveld 1, 3212 Lubbeek, Belgium

7. Division of Podiatry, Institut D’Enseignement Supérieur Parnasse Deux-Alice, Haute Ecole Leonard de Vinci, Avenue e Mounier 84, 1200 Bruxelles, Belgium

8. Department of Podiatry, Artevelde University College, Hoogpoort 15, 9000 Gent, Belgium

Abstract

Purpose: Trimalleolar ankle fractures (TAFs) are common traumatic injuries. Studies have described postoperative clinical outcomes in relation to fracture morphology, but less is known about foot biomechanics, especially in patients treated for TAFs. The aim of this study was to analyze segmental foot mobility and joint coupling during the gait of patients after TAF treatment. Methods: Fifteen patients, surgically treated for TAFs, were recruited. The affected side was compared to their non-affected side, as well as to a healthy control subject. The Rizzoli foot model was used to quantify inter-segment joint angles and joint coupling. The stance phase was observed and divided into sub-phases. Patient-reported outcome measures were evaluated. Results: Patients treated for TAFs showed a reduced range of motion in the affected ankle during the loading response (3.8 ± 0.9) and pre-swing phase (12.7 ± 3.5) as compared to their non-affected sides (4.7 ± 1.1 and 16.1 ± 3.1) and the control subject. The dorsiflexion of the first metatarsophalangeal joint during the pre-swing phase was reduced (19.0 ± 6.5) when compared to the non-affected side (23.3 ± 8.7). The affected side’s Chopart joint showed an increased range of motion during the mid-stance (1.3 ± 0.5 vs. 1.1 ± 0.6). Smaller joint coupling was observed on both the patient-affected and non-affected sides compared to the controls. Conclusion: This study indicates that the Chopart joint compensates for changes in the ankle segment after TAF osteosynthesis. Furthermore, reduced joint-coupling was observed. However, the minimal case numbers and study power limited the effect size of this study. Nevertheless, these new insights could help to elucidate foot biomechanics in these patients, adjusting rehabilitation programs, thereby lowering the risk of postoperative long-term complications.

Funder

Belgian Society of Orthopedics and Traumatology

Publisher

MDPI AG

Subject

General Medicine

Reference29 articles.

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