Der Unfallchirurg

A new continuous gait analysis system for ankle fracture aftercare

B. J. Braun, N. T. Veith, S. C. Herath, R. Hell, M. Rollmann, M. Orth, J. H. Holstein, T. Pohlemann

Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes


aftercare, ankle fracture, plantar pressure


Background Correct aftercare following lower extremity fractures remains a controversial issue. Reliable, clinically applicable weight-bearing recommendations have not yet been defined. The aim of the current study was to establish a new gait analysis insole during physical therapy aftercare of ankle fractures to test patients’ continuous, long-term compliance to partial weight-bearing restrictions and investigate whether patients can estimate their weight-bearing compliance. Materials and Methods The postoperative gait of 14 patients after operative treatment of Weber B-type ankle fractures was monitored continuously for six weeks (OpenGO, Moticon GmbH, Munich). All patients were instructed and trained by physical therapists on how to maintain partial weight-bearing for this time. Discontinuous (three, six and twelve weeks) clinical (patient questionnaire, visual analogue pain score [VAS]) and radiographic controls were performed. Results Despite the set weight-bearing limits, individual ranges for overall weight-bearing (range 5–107% of the contralateral side) and patient activity (range 0–366 min/day) could be shown. A good correlation between weight-bearing and pain was seen (rs = −0.68; p = <0.0001). Patients significantly underestimated their weight-bearing time over the set limit (2.3 ± 1.4 min/day vs. real: 12.6 ± 5.9 min/day; p < 0.01). Conclusions Standardized aftercare protocols and repeated training alone cannot ensure compliance to postoperative partial weight-bearing. Patients unconsciously increased weight-bearing based on their pain level. This study shows that new, individual and possibly technology-assisted weight-bearing regimes are needed. The introduced measuring device is feasible to monitor and steer patient weight-bearing during future studies.

Moticon's Summary

This study addresses the contentious issue of appropriate aftercare following lower extremity fractures, specifically ankle fractures, and the lack of reliable weight-bearing guidelines. Specifically, it was aimed to evaluate Moticon’s OpenGo sensor insole for monitoring compliance with partial weight-bearing restrictions. Fourteen patients with Weber B-type ankle fractures were continuously monitored postoperatively for six weeks using the OpenGo system. Patients were trained to maintain partial weight-bearing, with periodic clinical and radiographic evaluations. Results showed a wide range in weight-bearing and activity levels, revealing that patients significantly underestimated their weight-bearing time. There was a strong correlation between weight-bearing and pain. The study concludes that standardized protocols and training are insufficient for ensuring compliance, as patients tend to increase weight-bearing unconsciously according to pain levels. The findings suggest the need for individualized, technology-assisted weight-bearing regimes, highlighting the feasibility of the introduced sensor insoles for future studies.

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