On tibial plateau fractures Gait function and patient experiences

Abstract

Clinical and scientific experience has shown that some patients with tibial plateau fractures face persistent issues long after the injury, posing challenges for patients and healthcare providers. The primary aim of this thesis is to comprehensively understand both the objective and subjective aspects of recovery following tibial plateau fractures, focusing on gait function assessed through three-dimensional marker-based motion capture (MOCAP) analysis and patient experiences of the rehabilitation process, captured through qualitative interviews.

A validation study (Study I) compared MOCAP analysis with radiostereometric analysis (RSA) for assessing dynamic knee movements (n=12). Studies II (n=20) and III (n=26) followed patients with surgically and non-surgically treated tibial plateau fractures over three to 24 months, utilizing MOCAP analysis. At three months, knee function was also evaluated through a 6-minute walk test and range of motion (ROM) in the knee joint. In Study IV (n=19), surgically treated patients were interviewed 24 months post-injury about their rehabilitation experience, with interviews analysed using qualitative content analysis.

Compared with RSA, knee flexion was underestimated using MOCAP analysis, a factor to consider when reviewing patient data. In Studies II and III, patients showed difficulties achieving full knee extension during gait. While knee power generation improved over time, ROM did not show significant improvement six months post-injury. Two themes emerged from the interviews: (i) the desire for individualised care, and (ii) the physical and psychological changes experienced from the time of injury onwards. Patients with tibial plateau fractures continue to experience difficulties up to two years post-injury. While knee power generation improves after six months, range of motion remains limited. Many patients report ongoing challenges, although much of their daily function has returned to normal. Additionally, instrumental gait analysis is considered a valid method for measuring dynamic knee flexion and extension during gait, despite a tendency to underestimate actual movement.