Spatiotemporal gait analysis and functional outcome after surgical treatment of calcaneal fractures in children


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Spatiotemporal gait analysis and functional outcome after surgical treatment of calcaneal fractures in children
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Université de Lausanne, Faculté de biologie et médecine
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0.1) Background: The purpose of this study was to evaluate the functional and clinical outcome in
children having undergone an open reduction with internal fixation (ORIF), for a displaced
intraarticular calcaneal fracture, as well as to analyze their gait characteristics with a spatiotemporal
gait analysis and compare the results obtained with a control group.
0.2) Methods: All children, aged between 0-18 years old, operated from an intraarticular displaced
calcaneal fracture between 2007-2017 in Lausanne and with informed consent were reviewed. We
analyzed their medical files and radiographies, they filled in questionnaires about their quality of life
(EQ-5D-Y) and about the functional outcome of the surgery (AOFAS ankle-hindfoot), they underwent
a clinical exam of both, ankles and feet, and a spatiotemporal gait analysis using the Gait up system,
Physilogâ. Every score of the questionnaires and parameter of the gait analysis, like the stride length,
the stance, the swing, the loading,… were then compared to the control’s data.
0.3) Results: We reviewed six patients operated for an intraarticular displaced calcaneal fracture and
fifteen control cases. None of our six patients was suffering obvious walking impairments nor was
strictly restrained in his daily life activities. However, some statistically significant discrepancies were
pointed out in walking parameters compare with the control group. Our patients were globally older
(p<0.0592) and taller (p<0.0436) than the controls. This has been playing a distinction in stride length
(p<0.001) since taller people take physiologically longer steps. Patients having undergone a surgery
for a calcaneal fracture were recorded with a faster maximal swing speed (p<0.029) and a smaller
minimal toe clearance (p<0.037). The difference in 3D path length (p<0.0001) in between the controls
and our patients was also statistically significative.
0.4) Discussion: The maximal swing speed and the minimal toe clearance, both having an impact
on the probability of tripping, were modified in operated patients, increasing their risk of falling; this,
though, was not observed during our study. The 3D path length expresses the length of a step in terms
of swing width and stride length; it represents the circumduction. Its value was also significantly
different in between the controls and our patients, meaning that operated patients do have a distinct
manner of taking steps since the foot movement after the surgery is modified due to stiffness in the
hindfoot and the decrease of eversion. Compared to the controls, our patients statistically had a longer
stride length, a smaller clearance and seemed to have a restricted swing width.
0.5) Conclusion: Even if there is no subjective activity limitation, we could highlight differences in
term of subtalar mobility and correlate them with modifications in some gait parameters within the
fracture group. These limitations are potential indicators for developing overload of adjacent
articulation and subsequent early arthritis. Therefore, we think that the restoration of the calcaneum
anatomy with an anatomic reduction and realignment of the posterior facet of the subtalar joint is a
relevant point for an efficacious recovery and in order to minimize later gait disbalance or disabilities,
thus offering the injured child the best future in terms of gait motion and quality of life. Finally, the
spatiotemporal gait analysis is useful to assess walking parameters and is a great means of evaluation
as well as a good follow-up tool.
Calcaneal fracture, Children, ORIF, Gait analysis
Création de la notice
02/09/2019 16:50
Dernière modification de la notice
08/09/2020 7:08
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