Original Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Orthop. Oct 18, 2013; 4(4): 259-266
Published online Oct 18, 2013. doi: 10.5312/wjo.v4.i4.259
Collecting a comprehensive evidence base to monitor fracture rehabilitation: A case study
Stuart A Callary, Dominic Thewlis, Alex V Rowlands, David M Findlay, Lucian B Solomon
Stuart A Callary, David M Findlay, Lucian B Solomon, Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, 5000 South Australia, Australia
Stuart A Callary, David M Findlay, Lucian B Solomon, Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, 5000 South Australia, Australia
Dominic Thewlis, Alex V Rowlands, School of Health Sciences, University of South Australia, Adelaide, 5000 South Australia, Australia
Author contributions: Solomon LB designed the study and performed the surgery on both patients included in this study; Callary SA performed the radiostereometric analysis radiographic examinations and subsequent measurements; Rowlands AV performed the activity monitoring; Thewlis D performed the gait analysis and subsequent analysis; all authors contributed to detailed analysis, interpretation of results, and the preparation of the manuscript.
Correspondence to: Lucian B Solomon, Associate Professor, Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Level 4, Bice Building, Adelaide, 5000 South Australia, Australia. bogdansolomon@mac.com
Telephone: +61-8-82222665 Fax: +61-8-82323065
Received: June 14, 2013
Revised: August 1, 2013
Accepted: September 4, 2013
Published online: October 18, 2013

AIM: To determine the feasibility and potential role of combining radiostereometric analysis (RSA), gait analysis and activity monitoring in the follow-up of fracture patients.

METHODS: Two patients with similar 41B3 tibial plateau fractures were treated by open reduction internal fixation augmented with impaction bone grafting and were instructed to partial weight bear to 10 kg for the first six postoperative weeks. Fracture reduction and fixation were assessed by postoperative computer tomographic (CT) scanning. Both patients had tantalum markers inserted intra-operatively to monitor their fracture stability during healing using RSA and differentially loaded RSA (DLRSA) at 6 and 12 wk postoperatively. Gait analyses were performed at 1, 2, 6, and 12 wk postoperatively. Activity monitors were worn for 4 wk between the 2 and 6 wk appointments. In addition to gait analysis, knee function was assessed using the patient reported Lysholm scores, and doctor reported knee range of motion and stability, at 6 and 12 wk postoperatively.

RESULTS: There were no complications. CT demonstrated that both fractures were reduced anatomically. Gait analysis indicated that Patient 1 bore weight to 60% of body weight at 2 wk postoperative and 100% at 6 wk. Patient 2 bore weight at 10% of body weight to 6 wk and had very low joint contact forces to that time. At 12 wk however, there was no difference between the gait patterns in the two patients. Patient 1 increased activities of moderate-vigorous intensity from 20 to 60 min/d between 2 and 6 postoperative weeks, whereas Patient 2 remained more stable at 20-30 min/d. The Lysholm scores were similar for both patients and did not improve between 6 and 12 wk postoperatively. DLRSA examination at 12 wk showed that both patients were comfortable to weight bear to 80 kg and under this weight the fractures displaced less than 0.4 mm. RSA measurements demonstrated over time fracture migrations of less than 2 mm in both cases. However, Patient 2, who followed the postoperative weight bearing instructions most closely, displaced less (0.3 mm vs 1.6 mm).

CONCLUSION: This study demonstrates the potential of using a combination of RSA, gait analysis and activity monitoring to obtain a comprehensive evidence base for postoperative weight bearing schedules during fracture healing.

Keywords: Radiostereometric analysis, Gait analysis, Activity monitoring, Rehabilitation protocols, Lower limb trauma

Core tip: The extent to which patients follow rehabilitation instructions, likely affects not only the early recovery, but also the long-term outcomes that are dependent on maintenance of fracture reduction. We have demonstrated the feasibility of using radiostereometric analysis, gait analysis and activity monitoring to assess early fracture healing. Future larger clinical studies using this novel combination of assessment tools may provide an evidence base for particular rehabilitation schedules following different fracture types and fixation techniques.