Purpose. Pilon fracture is a severe injury which has a great impact on the patients' lives, but in what extend is not clear yet in the literature. The purpose of this study was to investigate the gait alternations after treatment of patients who had pilon fractures. Materials & Methods. We have evaluated the gait pattern of patients who were treated with circular Ilizarov frame following pilon fractures in our department. The gait was tested by using a force plate in a walking platform. Ground Reaction Forces (GRF) and timing of gait phases data were collected during level walking at self-selected speeds. The patients performed two walking tasks for each limb and the collected data were averaged for each limb. Demographic, clinical, radiological, trauma outcome (COST) and quality of life questionnaire (SF-12) data were also collected. Results. We have analysed the gait through the GRF of twelve patients (aged 44.9 ±12.4 years), who had undergone treatment with circular Ilizarov frame following pilon fractures (67% were male). The tests were performed at an average of 10.5 months after the initial treatment. SF-12 Mental scores have returned to normal (mean 56.4 ±11.6) but physical scores remained impaired (mean 41.8 ±8.4). COST questionnaire scores reached average levels (47.1 ±15) in all dimensions (Symptoms: 51.4 ±16, Function: 44 ±14 and Mental Status: 56.6 ±16). During the push-off phase all the plantar flexor muscles are activated and the ankle plantar flexes to achieve the push off. It seems that this motion, is not achieved adequately with the affected limb and the patients are using their normal limb earlier (pre-swing is the start of the double support of the gait) in order to progress in their gait circle. Conclusions. Ten months following treatment with circular ilizarov frame for pilon fracture the patients still have impaired gait pattern. The differences can be explained by the lack of plantar flexion of the ankle which results to poorer push-off of the affected limb

Introduction. There is limited evidence assessing the effect of the Ankle Foot Orthosis (AFO) on gait improvements in diplegic cerebral palsy. In particular, the effect of the AFO on vertical forces during gait has not been reported. Appropriate vertical ground reaction forces are crucial in enabling children with CP to walk efficiently. This study investigated the effect of AFO application on the vertical forces in gait, particularly the second vertical peak in force (FZ2) in late stance. The force data was compared with the barefoot walk. Patients and Methods. A retrospective analysis of nineteen children (8M,11F) who met inclusion criteria of a diagnosis of spastic diplegic CP, ability to walk independently barefoot and also using bilateral rigid AFOs were included. Gait data were acquired using the Vicon-Nexus ® motion-capture. Resulting ground reaction force data were recorded. Appropriate statistical methods assessed significance between barefoot and AFO data. Results. 68.4% of subjects experienced increase in FZ2 magnitude in left leg and 63.2% experienced objective increase in right leg after AFO application. Mean increased in FZ2 was 5.33N in left leg and 8.53 N in right leg. Results indicate significant improvement in amplitude of FZ2 generation with AFO application, significantly increased gait efficiency, and a significantly normalized pattern of vertical force produced during gait. Discussion. The AFO is effective in enabling children with diplegic CP to achieve efficient gait patterns. Our study is the first to our knowledge that focuses on the effect of AFO on specifically vertical ground reaction force produced in gait

Background:. Little is known about the forces carried by the Taylor Spatial Frame (TSF) hexapod fixator. Our aim was to measure the TSF resultant force and how this changed during the consolidation phase. Method:. Five patients undergoing correction of tibial deformities were recruited. Measurements were taken at 2, 4, 8 and 12 weeks post-correction during various activities. Instrumented struts incorporating strain gauges measuring axial force were temporarily used each time. Strut forces and lengths were used to determine frame kinetics. The resultant axial fixator forces and moments were calculated relative to sitting. Ground reaction forces (GRF) were measured using the treadmill force plates. Results & Discussion:. Due to the subjects' varying confidence in weight bearing the forces varied both inter- and intra-activity and over post-corrective time. Variation in individual strut forces produced a resultant force and bending moment across the fixation. As the healing bone assumed more load over time there was a reduction in the force and bending excursions across the frame as a percentage of GRF, achieving a minimum by 8 weeks. Conclusion:. Instrumented TSFs are a useful means of assessing the forces acting during healing. Monitoring of these forces can determine optimal removal

Purpose. Tibia plateau fractures are severe knee injuries which have a great impact on the patients' lives, but in what extend is not clear yet in the literature. The purpose of this study was to investigate the gait alternations after treatment of patients who had severe tibia plateau fractures which were treated with circular ilizarov frame. Materials & Methods. We have evaluated the gait pattern of patients who were treated with circular Ilizarov frame after severe tibia plateau fractures (Schatzker IV-VI) in our department. The gait was tested by using a force plate in a walking platform. Ground Reaction Forces (GRF) data were collected during level walking at self-selected speeds. The patients performed two walking tasks for each limb and the collected data were averaged for each limb. Demographic, clinical, radiological and quality of life questionnaire (SF-12) data were also collected. Results. We have analysed the gait through the GRF of fifteen patients (aged 50.8 ±17.3 years), who had undergone treatment with circular Ilizarov frame following severe tibia plateau fractures (Schatzker IV-VI). Nine were male and six were female. The tests were performed at an average of 13.2 months after the initial treatment. SF-12 Mental scores have returned to normal (mean 54.6 ±12.3) but physical scores remained impaired (mean 40.6 ±10.8). A one-way repeated measures ANOVA was conducted to compare the GRFs and gait timing data of the affected limb with the normal one. Single limb support interval was significantly reduced to the affected limb (p=0.001) and terminal stance phase was prolonged for the normal limb (p=0.035). During this phase of the gait circle the knee is on its maximum flexion and the quadriceps contracts to bring the femur above the tibia. It seems that these patients during the gait circle reduce the flexion of their affected knee to make their single stance shorter. To the normal limb the patients manage to reduce more the GRFs during the mid-stance phase (F2 force), this difference do not reach significance, but illuminates the tendency of reduced knee flexion in that phase. The rest of the GRF and gait timing data did not had significant differences. Conclusions. One year after severe tibia plateau fracture treated with circular ilizarov frame the patients manage to return to almost normal gait pattern. Reduce single limb stance and terminal stance phase to the affected knee can be explained by the tendency of not flexing their deficient knee as much during that gait phase

Summary. Revision TKA using CCK prosthesis showed comparable outcome to PS prosthesis in clinical and radiological results. Introduction. In revision total knee arthroplasty (TKA), the goal should be to obtain good motion, function and most importantly stability. The stability depends on remaining soft tissue and implant design. The more the ligaments retain function, the less the implant constraint is needed to achieve stability. With increased constraint, the transfer of joint reaction forces to implant-bone interface may lead to mechanical loosening of the implant. Constrained condylar knee (CCK) prosthesis provides more constraint compared with posterior stabilized (PS) prosthesis. The purpose of this study was to compare the clinical, radiological outcome and survivorship of CCK and PS prosthesis in revision TKA. Materials and Methods. One hundred and twenty-one consecutive revision TKAs using CCK (79 knees) and PS (42 knees) were included. The mean follow-up period was 63.2 months for CCK and 64.8 months for PS. The mean age was 69.5 years and 70.6 years in CCK and PS, respectively. Range of motion (ROM), American Knee Society (AKS) score, Hospital for Special Surgery (HSS) score, complications and failure rate were assessed. Radiographic measurements included tibiofemoral angle and radiolucent lines. The Kaplan-Meier survivorship analysis was performed with an end point of re-revision surgery for any reason and compared between CCK and PS using the Log-rank test. Results. The mean range of motion improved from 97.5° to 115.9° in PS, from 89.5° to 110.1° in CCK. The mean Knee Society knee and functional scores improved from 47.6 and 36.4 to 89.7 and 66.1 with PS, from 53.5 and 41.7 to 79.2 and 66.8 with CCK. The mean Hospital for Special Surgery knee score also improved from 57 to 76.9 and 59.7 to 77.6, respectively. The complication rate was 7.5% (4 cases; 3 recurred infections, 1 instability) in PS and 10.3% (7 cases; 4 recurred infections, 1 periprosthetic fracture, 2 stem tip pains) in CCK. The Kaplan–Meier survivorship analysis revealed that ten year survival of the components was 85.4% for PS and 80.0% for CCK. In all aspects, there were no statistical difference (a p-value of more than 0.05) between PS and CCK. Conclusion. Revision TKA using CCK prosthesis showed comparable outcome to PS prosthesis in clinical and radiological results. CCK prosthesis is a reliable and successful option for prosthesis selection in revision TKA when PS prosthesis is not enough for management of instability