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Ein neues, kontinuierliches Ganganalysesystem zur Nachbehandlung von Sprunggelenkfrakturen

A new continuous gait analysis system for ankle fracture aftercare

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Zusammenfassung

Hintergrund

Die Nachbehandlung von Frakturen der unteren Extremität wird hinsichtlich der optimalen Gangbelastung kontrovers diskutiert. Zuverlässige Daten zum korrekten Belastungsausmaß liegen auch aufgrund fehlender, in der klinischen Breitenversorgung etablierter Messmethoden nicht vor.

Ziel der Arbeit

Ziel der Arbeit war es eine kontinuierliche Belastungs- und Complianceüberwachung von Patienten während der physiotherapeutischen Nachbehandlung von operativ versorgten Sprunggelenkfrakturen mit einer neuen Pedobarographiesohle durchzuführen. Es sollte dabei überprüft werden, ob und wie weit Patienten von unseren vorgegebenen Belastungsstandards abweichen, inwieweit dabei das patienteneigene Schmerzempfinden zur Steuerung beiträgt und ob Patienten Ihre Belastung korrekt einschätzen können.

Methodik

Bei 14 Patienten wurde nach operativer Versorgung von Sprunggelenkfrakturen Typ Weber B eine kontinuierliche Ganganalyse (OpenGO, Moticon GmbH, München) für 6 Wochen durchgeführt. Eine 6‑wöchige Teilbelastung wurde vorgegeben und physiotherapeutisch angeleitet. Die Patienten wurden diskontinuierlich (nach 3, 6 und 12 Wochen) klinisch und radiologisch kontrolliert.

Ergebnisse

Es zeigten sich hoch individuelle Belastungsmuster sowohl für die Bodenreaktionskraft (Range 5–105 % der Gegenseite) als auch für die Aktivität (Range 0–366 min pro Tag). Die Aufbelastung zeigte sich mit dem Schmerz korreliert (rs = −0,68; p = <0,01). Alle Patienten unterschätzten ihre tatsächliche Gangüberbelastung signifikant (2,3 ± 1,4 min/Tag vs. real: 12,6 ± 5,9 min/Tag; p < 0,01).

Diskussion

Trotz Anleitung konnte eine Teilbelastung im postoperativen Verlauf nach Sprunggelenkfrakturen nicht wie vorgegeben eingehalten werden. Der Heilungsverlauf wurde dadurch nicht negativ beeinflusst. Neue, individuelle Nachbehandlungsstandards, die dem Patientenbefinden gerecht werden, sollten entitätsspezifisch definiert werden. Die vorgestellte Messtechnik kann dabei zur Überwachung und Steuerung dienen.

Abstract

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.

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Danksagung

Wir danken der AO Foundation für die Bereitstellung des Studienmaterials.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str., 66421, Homburg, Deutschland

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

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  1. B. J. Braun
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  2. N. T. Veith
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  3. S. C. Herath
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  4. R. Hell
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  5. M. Rollmann
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  6. M. Orth
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  7. J. H. Holstein
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  8. T. Pohlemann
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Corresponding author

Correspondence to B. J. Braun.

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Interessenkonflikt

T. Pohlemann ist Chairman des TK-Systems der AO Foundation. Als Nutzer einer frühen Prototypenversion der Sohle waren die Autoren beratend an Softwareupdateentwicklungen der Firma Moticon GmbH beteiligt. Finanzielle oder Sachmittel wurden abseits der o. g. Förderung nicht bezogen. B.J. Braun, N.T. Veith, S.C. Herath, R. Hell, M. Rollmann, M. Orth und J.H. Holstein geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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W. Mutschler, München

H. Polzer, München

B. Ockert, München

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Braun, B.J., Veith, N.T., Herath, S.C. et al. Ein neues, kontinuierliches Ganganalysesystem zur Nachbehandlung von Sprunggelenkfrakturen. Unfallchirurg 121, 293–299 (2018). https://doi.org/10.1007/s00113-017-0332-3

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  • DOI: https://doi.org/10.1007/s00113-017-0332-3

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