3D gait analysis in patients treated for high-grade tibial plateau fractures (Schatzker VI) with closed reduction and external fixation with circular frames.

Abstract

Background: Tibial plateau fractures (TPF) are complex injuries that may lead to long-term functional deficits despite surgical management. This study aims to evaluate gait biomechanics in patients with severe tibial plateau fractures (Schatzker VI) treated with circular external fixation METHODS: Eighteen patients (mean age 46.3 ± 12.9 years; 19.8 months median follow up) underwent a fully instrumented three-dimensional gait analysis (3DGA), isokinetic strength testing of knee extensors and flexors, and completed self-reported outcomes for quality of life (EQ-5D) and knee-specific function (KOOS). An age- and sex-matched control group (n = 36) served as reference.

Results: While only subtle kinematic asymmetries were observed between the healthy and affected limbs, knee excursion in the operated limb was significantly reduced during stance (Δ = -2°, p = 0.039). Joints' kinematics showed overall mild deviations, with no major angular deficits except from the hip and ankle joints. In contrast, kinetic impairments were evident. Ankle plantarflexion moment was reduced by 13.6 % in the operated limb compared to controls (p < 0.001, d = 1.08), and forward propulsive ground reaction force (GRF) was 5.5 % body mass lower (p < 0.001, d = 1.30). The second vertical GRF peak was also significantly diminished (-11.4 % body mass, p < 0.001, d = 1.03). The healthy limb exhibited milder but consistent kinetic alterations. Isokinetic testing revealed significant strength asymmetries, especially reduced quadriceps torque in the operated limb. EQ-5D and KOOS scores were significantly below normative values, though only moderately associated with gait metrics.

Conclusion: These findings highlight persistent kinetic impairments months after injury, emphasizing the need for comprehensive lower-limb evaluation and targeted rehabilitation programs that extent beyond the injured joint alone.