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

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.