# Differences Between Tibial or Malleolar Fracture Types and Union or Nonunion in Spatiotemporal and Kinematic Gait Parameters Throughout Healing: An Observational Study

## TL;DR

This study compares gait changes in patients with different lower leg fractures and finds that malleolar fractures recover most fully within six months.

## Contribution

The study identifies specific gait parameter differences across fracture types and healing stages using motion capture.

## Key findings

- Malleolar fractures showed full recovery of gait parameters after six months.
- Proximal tibial fractures had reduced knee range of motion compared to other types at six months.
- Tibial shaft fractures with nonunion showed stance time asymmetry at six weeks and six months.

## Abstract

Gait analyses are becoming increasingly relevant in digital medicine. For implementation in clinical practice, knowledge on differences between gait patterns of separate bone fracture types is required. The aim of this study was to compare longitudinal changes in gait of patients with proximal tibial, tibial shaft, and malleolar fractures, as well as nonunion.

Patients with a proximal tibial, tibial shaft, or malleolar fracture requiring surgery were prospectively enrolled in this longitudinal observational study. A healthy control group received one measurement. Optical motion capture was used to obtain spatiotemporal gait parameters and kinematics at 6 weeks, 3 months, and 6 months after surgery.

In total, 73 patients (51.1 ± 16.9 years) and 43 controls (50.5 ± 17.7 years) were included. Only in malleolar fractures, all gait parameters had returned to normal after 6 months. Differences between fracture types at 6 weeks were found in step height (P = 0.01), knee range of motion (ROM, P < 0.001), and its asymmetry (P < 0.001). At 6 months, knee ROM was still lower in proximal tibial than tibial shaft and malleolar fractures (P = 0.04; 0.047). Tibial shaft fractures with and without nonunion differed in stance time (P = 0.007; 0.02) and its asymmetry (P = 0.007; 0.009) after 6 weeks and 6 months, but not at 3 months.

When monitoring fracture healing with motion capture, differences between fracture types and their timely appearance should be considered.

The study was prospectively registered in the German Clinical Trials Register DRKS00025108.

The online version contains supplementary material available at 10.1007/s10439-025-03937-2.