PMID- 30811361
OWN - NLM
STAT- MEDLINE
DCOM- 20200120
LR  - 20210109
IS  - 1528-1132 (Electronic)
IS  - 0009-921X (Print)
IS  - 0009-921X (Linking)
VI  - 477
IP  - 4
DP  - 2019 Apr
TI  - Do Spatiotemporal Gait Parameters Improve After Pilon Fracture in Patients Who 
      Use the Intrepid Dynamic Exoskeletal Orthosis?
PG  - 838-847
LID - 10.1097/CORR.0000000000000487 [doi]
AB  - BACKGROUND: Pilon fractures are high-energy fractures about the ankle observed 
      commonly in both civilian and military trauma populations. Despite surgical 
      management, outcomes are predictably poorly characterized by functional deficits 
      secondary to pain and stiffness. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) 
      and Return-to-Run clinical pathway were initially designed to treat military 
      service members after complex battlefield lower extremity injuries. The IDEO has 
      been used to treat nonbattlefield injuries, but, to our knowledge, it has not 
      been studied specifically among patients with pilon fractures. By studying the 
      use of the IDEO in this patient population, we hope to learn how it might improve 
      ambulation in the community, relieve pain, and return patients to work to better 
      identify patients who might benefit from its use. QUESTIONS/PURPOSES: The purpose 
      of this study was to determine whether the IDEO would improve gait parameters 
      including velocity, cadence, stride length, and single-leg stance duration in 
      patients with pilon fractures. Our secondary endpoints of interest were 
      reductions in pain and return to duty. METHODS: A prospectively collected 
      database of all active-duty IDEO users at a single institution was queried for 
      all patients using the IDEO after a pilon fracture. Patients were included if 
      they were using the IDEO after sustaining a surgically treated pilon fracture and 
      had exhausted all nonoperative therapies. Exclusions were patients with an 
      incomplete gait analysis at the two study time points. Seven patients meeting 
      these criteria were identified. Three-dimensional gait analysis was performed two 
      times: first wearing shoes at a self-selected speed and second after a 
      custom-made IDEO was fabricated for the patient and completion of the 
      Return-to-Run pathway. Patients reported their average pain while ambulating 
      using a numeric rating scale. Gait variables of interest were velocity, cadence, 
      stride length, and single stance time. Return to military service was assessed 
      through the military medical record. To return to duty, a service-specific 
      physical readiness test must be completed. RESULTS: Median gait velocity improved 
      from 1.1 (interquartile range [IQR], 0.9-1.2) to 1.3 m/s (IQR, 1.2-1.5; p = 
      0.01). All other variables did not change: cadence 98.4 (IQR, 93.0-107.2) to 
      104.5 steps/min (IQR, 103.0-109.0; p = 0.13), affected stride length 1.3 (IQR, 
      1.0-1.4 m) to 1.4 m (IQR, 1.3-1.6 m; p = 0.07), and affected single stance 0.42 
      (IQR, 0.41-0.47) to 0.43 (IQR, 0.42-0.44; p = 0.80). Pain did not change between 
      time points: 3 (IQR, 2-3) to 2.5 (IQR, 1-3.5; p = 0.90). Three of seven patients 
      returned to duty. CONCLUSIONS: At self-selected walking speeds, we observed no 
      improvements in gait parameters or pain after application of the IDEO that would 
      likely be considered clinically important, and so the device is unlikely to be 
      worth the cost in this setting. It is possible that for higher demand users such 
      as elite athletes, the IDEO could have a role after severe lower extremity 
      trauma; however, this must be considered speculative until or unless proven in 
      future studies. LEVEL OF EVIDENCE: Level III, therapeutic study.
FAU - Quacinella, Michael
AU  - Quacinella M
AD  - M. Quacinella, E. Bernstein, K. M. Kuhn, Department of Orthopedic Surgery, Naval 
      Medical Center San Diego, San Diego, CA, USA B. Mazzone, Extremity Trauma and 
      Amputation Center of Excellence, Naval Medical Center San Diego, San Diego, CA, 
      USA M. Wyatt, Department of Physical Therapy, Naval Medical Center San Diego, San 
      Diego, CA, USA.
FAU - Bernstein, Ethan
AU  - Bernstein E
FAU - Mazzone, Brittney
AU  - Mazzone B
FAU - Wyatt, Marilynn
AU  - Wyatt M
FAU - Kuhn, Kevin M
AU  - Kuhn KM
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Orthop Relat Res
JT  - Clinical orthopaedics and related research
JID - 0075674
SB  - IM
CIN - Clin Orthop Relat Res. 2019 Apr;477(4):848-849. PMID: 30376461
MH  - Adult
MH  - Ankle Fractures/diagnostic imaging/physiopathology/*rehabilitation
MH  - Databases, Factual
MH  - Equipment Design
MH  - *Exoskeleton Device
MH  - *Foot Orthoses
MH  - *Gait Analysis
MH  - Humans
MH  - Male
MH  - *Military Medicine
MH  - Pain/diagnostic imaging/physiopathology/*prevention & control
MH  - Recovery of Function
MH  - Registries
MH  - Retrospective Studies
MH  - Return to Work
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Walking Speed
MH  - Young Adult
PMC - PMC6437376
COIS- All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and 
      Related Research(R) editors and board members are on file with the publication and 
      can be viewed on request.
EDAT- 2019/02/28 06:00
MHDA- 2020/01/21 06:00
PMCR- 2020/04/01
CRDT- 2019/02/28 06:00
PHST- 2019/02/28 06:00 [pubmed]
PHST- 2020/01/21 06:00 [medline]
PHST- 2019/02/28 06:00 [entrez]
PHST- 2020/04/01 00:00 [pmc-release]
AID - CORR-D-18-00425 [pii]
AID - 10.1097/CORR.0000000000000487 [doi]
PST - ppublish
SO  - Clin Orthop Relat Res. 2019 Apr;477(4):838-847. doi: 
      10.1097/CORR.0000000000000487.