{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T06:27:46Z","timestamp":1787984866317,"version":"build-2784847793"},"reference-count":27,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AO North America via the AO Strategy Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>In a prospective study, we examined the recovery trajectory of patients with lower extremity fractures to better understand the healing process in the absence of complications. Using a chest-mounted inertial measurement unit (IMU) device for gait analysis and collecting patient-reported outcome measures, we focused on 12 key gait variables, including Mean Leg Lift Acceleration, Stance Time, and Body Orientation. We employed a linear mixed model (LMM) to analyze these variables over time, incorporating both fixed and random effects to account for individual differences and the time since injury. This model also adjusted for varying intervals between assessments. Our study provided insights into gait recovery across different fracture types using data from 318 patients who experienced no complications or readmissions during their recovery. Through LMM analysis, we found that Tibia-Distal fractures demonstrated the fastest recovery, particularly in terms of mobility and strength. Tibia-Proximal fractures showed balanced improvements in both mobility and stability, suggesting that rehabilitation should target both strength and balance. Femur fractures exhibited varied recovery, with Diaphyseal fractures showing clear improvements in stability, while Distal fractures reflected gains in limb strength but with some variability in stability. To examine patients with readmissions, we conducted a Chi-squared test of independence to determine whether there was a relationship between fracture type and readmission rates, revealing a significant association (p &lt; 0.001). Pelvis fractures had the highest readmission rates, while Tibia-Diaphyseal and Tibia-Distal fractures were more prone to infections, highlighting the need for enhanced infection control strategies. Femur fractures showed moderate readmission and infection rates, indicating a mixed risk profile. In conclusion, our findings emphasize the importance of fracture-specific rehabilitation strategies, focusing on infection prevention and individualized treatment plans to optimize recovery outcomes.<\/jats:p>","DOI":"10.3390\/bioengineering12010067","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T07:35:47Z","timestamp":1736840147000},"page":"67","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Analyzing Gait Dynamics and Recovery Trajectory in Lower Extremity Fractures Using Linear Mixed Models and Gait Analysis Variables"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9569-118X","authenticated-orcid":false,"given":"Mostafa","family":"Rezapour","sequence":"first","affiliation":[{"name":"Center for Artificial Intelligence Research, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel B.","family":"Seymour","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Wake Forest University School of Medicine, Charlotte, NC 28210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7765-1173","authenticated-orcid":false,"given":"Suman","family":"Medda","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Wake Forest University School of Medicine, Charlotte, NC 28210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen H.","family":"Sims","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Wake Forest University School of Medicine, Charlotte, NC 28210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhav A.","family":"Karunakar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Wake Forest University School of Medicine, Charlotte, NC 28210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3389-8323","authenticated-orcid":false,"given":"Nahir","family":"Habet","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Wake Forest University School of Medicine, Charlotte, NC 28210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2421-8229","authenticated-orcid":false,"given":"Metin Nafi","family":"Gurcan","sequence":"additional","affiliation":[{"name":"Center for Artificial Intelligence Research, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s40719-014-0004-5","article-title":"Rehabilitation of lower extremity trauma: A review of principles and military perspective on future directions","volume":"1","author":"Hoyt","year":"2015","journal-title":"Curr. Trauma Rep."},{"key":"ref_2","first-page":"509","article-title":"Weight bearing after a periarticular fracture: What is the evidence?","volume":"44","year":"2013","journal-title":"Orthop. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/1938640010374121","article-title":"Early weight bearing of calcaneal fractures fixated with locked plates: A radiographic review","volume":"3","author":"Hyer","year":"2010","journal-title":"Foot Ankle Spec."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.2106\/00004623-200210000-00001","article-title":"Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: A prospective, randomized, controlled multicenter trial","volume":"84","author":"Buckley","year":"2002","journal-title":"J. Bone Jt. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.injury.2007.09.003","article-title":"A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: Open reduction and internal fixation versus external Ilizarov fixation","volume":"39","author":"Bacon","year":"2008","journal-title":"Injury"},{"key":"ref_6","first-page":"427","article-title":"The Ilizarov method in the treatment of pilon fractures","volume":"4","author":"Zarek","year":"2002","journal-title":"Ortop. Traumatol. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.clinbiomech.2007.09.013","article-title":"Weight bearing after tibial fracture as a guide to healing","volume":"23","author":"Joslin","year":"2008","journal-title":"Clin. Biomech."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/00003086-199308000-00005","article-title":"Tibial external fixation, weight bearing, and fracture movement","volume":"293","author":"Kershaw","year":"1993","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/00005373-200104000-00019","article-title":"Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures: Is it a safe procedure?","volume":"50","author":"Arazi","year":"2001","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.2106\/00004623-199911000-00005","article-title":"Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail","volume":"81","author":"Brumback","year":"1999","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s00264-007-0411-0","article-title":"Results of osteosynthesis with the ITST nail in fractures of the trochanteric region of the femur","volume":"32","author":"Herrera","year":"2008","journal-title":"Int. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/BOT.0b013e318216b3e3","article-title":"Immediate full weightbearing after percutaneous fixation of anterior column acetabulum fractures","volume":"26","author":"Kazemi","year":"2012","journal-title":"J. Orthop. Trauma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/01.blo.0000119459.00792.c1","article-title":"Undisplaced intracapsular hip fractures: Results of internal fixation in 375 patients","volume":"421","author":"Conn","year":"2004","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"352","DOI":"10.2106\/00004623-199803000-00007","article-title":"Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture","volume":"80","author":"Koval","year":"1998","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_15","unstructured":"Whittle, M.W. (2014). Gait Analysis: An Introduction, Butterworth-Heinemann."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.gaitpost.2020.01.022","article-title":"Gait analysis and muscle weight analysis after lower extremity fractures in a small animal model","volume":"77","author":"Hofman","year":"2020","journal-title":"Gait Posture"},{"key":"ref_17","first-page":"186","article-title":"Human movement analysis using stereophotogrammetry: Part 1: Theoretical background","volume":"21","author":"Cappozzo","year":"2005","journal-title":"Gait Posture"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.gaitpost.2004.04.004","article-title":"Human movement analysis using stereophotogrammetry: Part 2: Instrumental errors","volume":"21","author":"Chiari","year":"2005","journal-title":"Gait Posture"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1007\/s00402-015-2325-4","article-title":"Gait characteristics and quality of life perception of patients following tibial plateau fracture","volume":"135","author":"Warschawski","year":"2015","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.gaitpost.2020.03.008","article-title":"Longitudinal changes in lower limb joint loading up to two years following tibial plateau fracture","volume":"78","author":"Millar","year":"2020","journal-title":"Gait Posture"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e032","DOI":"10.1097\/OI9.0000000000000032","article-title":"Electronically augmented gait abnormality assessment following lower extremity trauma","volume":"2","author":"Swart","year":"2019","journal-title":"OTA Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1002\/jor.25837","article-title":"Employing machine learning to enhance fracture recovery insights through gait analysis","volume":"42","author":"Rezapour","year":"2024","journal-title":"J. Orthop. Res."},{"key":"ref_23","unstructured":"Jiang, J., and Nguyen, T. (2007). Linear and Generalized Linear Mixed Models and Their Applications, Springer Nature."},{"key":"ref_24","unstructured":"Greenwood, P.E., and Nikulin, M.S. (1996). A Guide to Chi-Squared Testing, John Wiley & Sons."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Firebaugh, G., Warner, C., and Massoglia, M. (2013). Fixed effects, random effects, and hybrid models for causal analysis. Handbook of Causal Analysis for Social Research, Springer.","DOI":"10.1007\/978-94-007-6094-3_7"},{"key":"ref_26","first-page":"27","article-title":"Fitting linear mixed models in R","volume":"5","author":"Bates","year":"2005","journal-title":"R News"},{"key":"ref_27","first-page":"375","article-title":"Linear mixed models with endogenous covariates: Modeling sequential treatment effects with application to a mobile health study","volume":"35","author":"Qian","year":"2020","journal-title":"Stat. Sci. Rev. J. Inst. Math. Stat."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/12\/1\/67\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:28:23Z","timestamp":1759919303000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/12\/1\/67"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,14]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["bioengineering12010067"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering12010067","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,14]]}}}