Artikel
Improved early weight bearing by increased vertical loads after distal tibial fracture with an angle stable locking system compared to conventional intramedullary nailing
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Autoren
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Alison Agres
- Charité-Universitätsmedizin Berlin, Julius Wolff Institut, Berlin, Germany
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Dankward Höntzsch
- Berufgenossenschaftliche Unfallklinik Tübingen, Abteilung für Medizin-Technische Entwicklung, Tübingen, Germany
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René El Attal
- Universitätsklinik für Unfallchirurgie Innsbruck, Innsbruck, Austria
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Klaus-Dieter Schaser
- UniversitätsCentrum für Orthopädie und Unfallchirurgie (OUC), Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Germany
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Tim Pohlemann
- Universität des Saarlandes, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Homburg, Germany
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Alexander Joeris
- AO Clinical Investigation and Documentation, Dübendorf, Switzerland
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Denise Hess
- AO Clinical Investigation and Documentation, Dübendorf, Switzerland
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Georg Duda
- Charité - Universitätsmedizin Berlin, Julius Wolff Institut, Berlin-Brandenburger Centrum für Regenerative Therapien, Berlin, Germany
| Veröffentlicht: | 23. Oktober 2017 |
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Gliederung
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Objectives: Conventional unreamed intramedullary (IM) nailing of distal tibial fractures often results in high inter-fragmentary (IF) movements associated with pain, disuse, and possibly delayed bone healing. An angle stable locking system (ASLS) was developed and validated in sheep to minimize shear IF movement. Clinical work indicates that ASLS does not subjectively improve weight bearing compared to conventional systems; however, objective measures may offer more insight into early patient function.
Methods: Data from a previous multicenter prospective, randomized study were used, in which distal tibial fracture patients were randomized to conventional IM nailing (n=29) or ASLS (n=36) treatment. This study focuses on four out of eight centers with high compliance regarding gait measurement documentation. Static and dynamic vertical ground reaction forces were collected using a pressure plate at baseline, 6 weeks, 12 weeks, 6 months, and 12 months post-surgery. Center of pressure (COP) displacement and forefoot-hindfoot force distribution were measured during static trials. Force-time integrals, normalized to bodyweight, were calculated from walking trials.
Results and Conclusion: ASLS patients had significantly higher mediolateral COP displacements than conventional patients for the first four measurements, and higher anterior-posterior COP displacements for the first three time points. In baseline static measurements, ASLS patients also exhibited more evenly distributed forefoot and hindfoot forces than conventional patients. Furthermore, conventional patients exhibited higher asymmetry in overall force-time integrals.
ASLS patients appear more capable of applying higher vertical loads to the injured limb during both walking and standing compared to conventionally treated counterparts. Higher external load application suggests increased muscle activity, which may give ASLS patients an advantage in post-surgical functional recovery, which could reduce post-surgical muscle atrophy and its complications (Figure 1 [Fig. 1], Table 1 [Tab. 1]).
